Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.1 - release New Zealand flag

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

Resource Profile: NzPharmacyClaim - Detailed Descriptions

Draft as of 2025-08-31

Definitions for the NzPharmacyClaim resource profile.

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

0. Claim
Definition

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

ShortClaim, Pre-determination or Pre-authorization
Comments

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

Control0..*
Is Modifierfalse
Summaryfalse
Alternate NamesAdjudication Request, Preauthorization Request, Predetermination Request
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. Claim.implicitRules
Definition

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

ShortA set of rules under which this content was created
Comments

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

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

An Extension


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

ShortExtensionAdditional content defined by implementations
Comments

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

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

    Indicates the cohort for which the patient belongs, such as CRC, ARRC, LTC, CDOS, PRISON, etc.

    ShortPatient Cohort
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Patient Cohort) (Extension Type: CodeableConcept)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    8. Claim.extension:claimantNumber
    Slice NameclaimantNumber
    Definition

    The claimant number for the patient.

    ShortClaimant Number
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Claimant Number) (Extension Type: string)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    10. Claim.extension:originatingClaimantNumber
    Slice NameoriginatingClaimantNumber
    Definition

    The claimant number for the the previous owner.

    ShortOriginating Claimant Number
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Originating Claimant Number) (Extension Type: string)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    12. Claim.modifierExtension
    Definition

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

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

    ShortExtensions that cannot be ignored
    Comments

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

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

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

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

    The status of the resource instance.

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

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

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

    A code specifying the state of the resource instance.

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

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

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

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

    ShortCategory or discipline
    Comments

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

    Control1..1
    BindingUnless not suitable, these codes SHALL be taken from ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type
    (extensible to http://hl7.org/fhir/ValueSet/claim-type)

    The type or discipline-style of the claim.

    TypeCodeableConcept
    Is Modifierfalse
    Summarytrue
    Requirements

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

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

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

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

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

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

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

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

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

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

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

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

    The date this resource was created.

    ShortResource creation date
    Comments

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

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

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

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

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

    ShortParty responsible for the claim
    Comments

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

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

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

    ShortDesired processing ugency
    Comments

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

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

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

    TypeCodeableConcept
    Is Modifierfalse
    Summarytrue
    Requirements

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

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

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

    ShortSupporting information
    Comments

    Often there are multiple jurisdiction specific valuesets which are required.

    Control10..*
    TypeBackboneElement
    Is Modifierfalse
    Summaryfalse
    Requirements

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

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

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

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

    ShortExtensions that cannot be ignored even if unrecognized
    Comments

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

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

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

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

    A number to uniquely identify supporting information entries.

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

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

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

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

    ShortClassification of the supplied information
    Comments

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

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

    The valuset used for additional information category codes.

    TypeCodeableConcept
    Is Modifierfalse
    Summaryfalse
    Requirements

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

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

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

    ShortPatient insurance information
    Comments

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

    Control1..1*
    TypeBackboneElement
    Is Modifierfalse
    Summarytrue
    Requirements

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

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

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

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

    ShortExtensions that cannot be ignored even if unrecognized
    Comments

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

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

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

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

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

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

    To maintain order of the coverages.

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

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

    ShortCoverage to be used for adjudication
    Comments

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

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

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

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

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

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

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

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

    A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.

    ShortProduct or service provided
    Control10..*
    TypeBackboneElement
    Is Modifierfalse
    Summaryfalse
    Requirements

    The items to be processed for adjudication.

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

    An Extension


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

    ShortExtensionAdditional content defined by implementations
    Comments

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

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

      Indicates a flag relevant to the patient for the pharmacy claim.

      ShortPatient Flag
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Patient Flag) (Extension Type: boolean)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      52. Claim.item.extension:prescriberFlag
      Slice NameprescriberFlag
      Definition

      Indicates a flag relevant to the prescriber for the pharmacy claim.

      ShortPrescriber Flag
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Prescriber Flag) (Extension Type: boolean)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      54. Claim.item.extension:prescriptionFlag
      Slice NameprescriptionFlag
      Definition

      Indicates a flag relevant to the prescription for the pharmacy claim.

      ShortPrescription Flag
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Prescription Flag) (Extension Type: boolean)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      56. Claim.item.extension:doseFlag
      Slice NamedoseFlag
      Definition

      Indicates a flag relevant to the dose for the pharmacy claim.

      ShortDose Flag
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Dose Flag) (Extension Type: boolean)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      58. Claim.item.extension:groupId
      Slice NamegroupId
      Definition

      A group identifier relevant to the pharmacy claim.

      ShortGroup ID
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Group ID) (Extension Type: string)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      60. Claim.item.modifierExtension
      Definition

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

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

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

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

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

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

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

      A number to uniquely identify item entries.

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

      Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

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

      When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

      ShortBilling, service, product, or drug code
      Comments

      If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

      Control1..1
      BindingFor example codes, see USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls
      (example to http://hl7.org/fhir/ValueSet/service-uscls)

      Allowable service and product codes.

      TypeCodeableConcept
      Is Modifierfalse
      Summaryfalse
      Requirements

      Necessary to state what was provided or done.

      Alternate NamesDrug Code, Bill Code, Service Code
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      66. Claim.item.serviced[x]
      Definition

      The date or dates when the service or product was supplied, performed or completed.

      ShortDate or dates of service or product delivery
      Control10..1
      Typedate, Period
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Requirements

      Needed to determine whether the service or product was provided during the term of the insurance coverage.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      SlicingThis element introduces a set of slices on Claim.item.serviced[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
      • type @ $this
      • 68. Claim.item.serviced[x]:servicedDate
        Slice NameservicedDate
        Definition

        The date or dates when the service or product was supplied, performed or completed.

        ShortDate or dates of service or product delivery
        Control10..1
        Typedate, Period
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        Needed to determine whether the service or product was provided during the term of the insurance coverage.

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

        A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.

        ShortProduct or service provided
        Control10..*
        TypeBackboneElement
        Is Modifierfalse
        Summaryfalse
        Requirements

        The items to be processed for adjudication.

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

        An Extension


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

        ShortExtensionAdditional content defined by implementations
        Comments

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

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

          Indicates the balance owing for the pharmacy claim item detail.

          ShortBalance Owing
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Balance Owing) (Extension Type: string)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          76. Claim.item.detail.extension:wastageQuantity
          Slice NamewastageQuantity
          Definition

          Indicates the wastage quantity for the pharmacy claim item detail.

          ShortWastage Quantity
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Wastage Quantity) (Extension Type: Quantity)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          78. Claim.item.detail.extension:cbsSubsidy
          Slice NamecbsSubsidy
          Definition

          Indicates the CBS subsidy for the pharmacy claim item detail.

          ShortCBS Subsidy
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(CBS Subsidy) (Extension Type: Money)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          80. Claim.item.detail.extension:cbsPackSize
          Slice NamecbsPackSize
          Definition

          Indicates the CBS pack size for the pharmacy claim item detail.

          ShortCBS Pack Size
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(CBS Pack Size) (Extension Type: Quantity)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          82. Claim.item.detail.modifierExtension
          Definition

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

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

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

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

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

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

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

          A number to uniquely identify item entries.

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

          Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

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

          When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

          ShortBilling, service, product, or drug code
          Comments

          If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

          Control1..1
          BindingFor example codes, see USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls
          (example to http://hl7.org/fhir/ValueSet/service-uscls)

          Allowable service and product codes.

          TypeCodeableConcept
          Is Modifierfalse
          Summaryfalse
          Requirements

          Necessary to state what was provided or done.

          Alternate NamesDrug Code, Bill Code, Service Code
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          88. Claim.item.detail.quantity
          Definition

          The number of repetitions of a service or product.

          ShortCount of products or services
          Control10..1
          TypeQuantity(SimpleQuantity)
          Is Modifierfalse
          Summaryfalse
          Requirements

          Required when the product or service code does not convey the quantity provided.

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

          The quantity times the unit price for an additional service or product or charge.

          ShortTotal item cost
          Comments

          For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

          Control10..1
          TypeMoney
          Is Modifierfalse
          Summaryfalse
          Requirements

          Provides the total amount claimed for the group (if a grouper) or the line item.

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

          The total value of the all the items in the claim.

          ShortTotal claim cost
          Control10..1
          TypeMoney
          Is Modifierfalse
          Summaryfalse
          Requirements

          Used for control total purposes.

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

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

          0. Claim
          2. Claim.extension
          SlicingThis element introduces a set of slices on Claim.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 4. Claim.extension:patientCohort
            Slice NamepatientCohort
            Control0..1
            TypeExtension(Patient Cohort) (Extension Type: CodeableConcept)
            6. Claim.extension:claimantNumber
            Slice NameclaimantNumber
            Control0..1
            TypeExtension(Claimant Number) (Extension Type: string)
            8. Claim.extension:originatingClaimantNumber
            Slice NameoriginatingClaimantNumber
            Control0..1
            TypeExtension(Originating Claimant Number) (Extension Type: string)
            10. Claim.supportingInfo
            Control1..?
            12. Claim.insurance
            Control0..1
            14. Claim.item
            Control1..?
            16. Claim.item.extension
            SlicingThis element introduces a set of slices on Claim.item.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 18. Claim.item.extension:patientFlag
              Slice NamepatientFlag
              Control0..1
              TypeExtension(Patient Flag) (Extension Type: boolean)
              20. Claim.item.extension:prescriberFlag
              Slice NameprescriberFlag
              Control0..1
              TypeExtension(Prescriber Flag) (Extension Type: boolean)
              22. Claim.item.extension:prescriptionFlag
              Slice NameprescriptionFlag
              Control0..1
              TypeExtension(Prescription Flag) (Extension Type: boolean)
              24. Claim.item.extension:doseFlag
              Slice NamedoseFlag
              Control0..1
              TypeExtension(Dose Flag) (Extension Type: boolean)
              26. Claim.item.extension:groupId
              Slice NamegroupId
              Control0..1
              TypeExtension(Group ID) (Extension Type: string)
              28. Claim.item.serviced[x]
              Control1..?
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              SlicingThis element introduces a set of slices on Claim.item.serviced[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • type @ $this
              • 30. Claim.item.serviced[x]:servicedDate
                Slice NameservicedDate
                Control1..1
                Typedate
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                32. Claim.item.detail
                Control1..?
                34. Claim.item.detail.extension
                SlicingThis element introduces a set of slices on Claim.item.detail.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 36. Claim.item.detail.extension:balanceOwing
                  Slice NamebalanceOwing
                  Control0..1
                  TypeExtension(Balance Owing) (Extension Type: string)
                  38. Claim.item.detail.extension:wastageQuantity
                  Slice NamewastageQuantity
                  Control0..1
                  TypeExtension(Wastage Quantity) (Extension Type: Quantity)
                  40. Claim.item.detail.extension:cbsSubsidy
                  Slice NamecbsSubsidy
                  Control0..1
                  TypeExtension(CBS Subsidy) (Extension Type: Money)
                  42. Claim.item.detail.extension:cbsPackSize
                  Slice NamecbsPackSize
                  Control0..1
                  TypeExtension(CBS Pack Size) (Extension Type: Quantity)
                  44. Claim.item.detail.quantity
                  Control1..?
                  46. Claim.item.detail.net
                  Control1..?
                  48. Claim.total
                  Control1..?

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

                  0. Claim
                  Definition

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

                  ShortClaim, Pre-determination or Pre-authorization
                  Comments

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

                  Control0..*
                  Is Modifierfalse
                  Summaryfalse
                  Alternate NamesAdjudication Request, Preauthorization Request, Predetermination Request
                  Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                  dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
                  dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                  dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                  dom-6: A resource should have narrative for robust management (text.`div`.exists())
                  2. Claim.id
                  Definition

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

                  ShortLogical id of this artifact
                  Comments

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

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

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

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

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

                  ShortA set of rules under which this content was created
                  Comments

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

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

                  The base language in which the resource is written.

                  ShortLanguage of the resource content
                  Comments

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

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

                  A human language.

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

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

                  ShortText summary of the resource, for human interpretation
                  Comments

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

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

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

                  ShortContained, inline Resources
                  Comments

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

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

                  An Extension

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

                    Indicates the cohort for which the patient belongs, such as CRC, ARRC, LTC, CDOS, PRISON, etc.

                    ShortPatient Cohort
                    Control0..1
                    This element is affected by the following invariants: ele-1
                    TypeExtension(Patient Cohort) (Extension Type: CodeableConcept)
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    18. Claim.extension:claimantNumber
                    Slice NameclaimantNumber
                    Definition

                    The claimant number for the patient.

                    ShortClaimant Number
                    Control0..1
                    This element is affected by the following invariants: ele-1
                    TypeExtension(Claimant Number) (Extension Type: string)
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    20. Claim.extension:originatingClaimantNumber
                    Slice NameoriginatingClaimantNumber
                    Definition

                    The claimant number for the the previous owner.

                    ShortOriginating Claimant Number
                    Control0..1
                    This element is affected by the following invariants: ele-1
                    TypeExtension(Originating Claimant Number) (Extension Type: string)
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    22. Claim.modifierExtension
                    Definition

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

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

                    ShortExtensions that cannot be ignored
                    Comments

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

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

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

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

                    A unique identifier assigned to this claim.

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

                    Allows claims to be distinguished and referenced.

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

                    The status of the resource instance.

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

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

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

                    A code specifying the state of the resource instance.

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

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

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

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

                    ShortCategory or discipline
                    Comments

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

                    Control1..1
                    BindingUnless not suitable, these codes SHALL be taken from ClaimTypeCodes
                    (extensible to http://hl7.org/fhir/ValueSet/claim-type)

                    The type or discipline-style of the claim.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summarytrue
                    Requirements

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

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

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

                    ShortMore granular claim type
                    Comments

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

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

                    A more granular claim typecode.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

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

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

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

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

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

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

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

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

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

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

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

                    The period for which charges are being submitted.

                    ShortRelevant time frame for the claim
                    Comments

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

                    Control0..1
                    TypePeriod
                    Is Modifierfalse
                    Summarytrue
                    Requirements

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

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

                    The date this resource was created.

                    ShortResource creation date
                    Comments

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

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

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

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

                    Individual who created the claim, predetermination or preauthorization.

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

                    Some jurisdictions require the contact information for personnel completing claims.

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

                    The Insurer who is target of the request.

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

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

                    ShortParty responsible for the claim
                    Comments

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

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

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

                    ShortDesired processing ugency
                    Comments

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

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

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

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summarytrue
                    Requirements

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

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

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

                    ShortFor whom to reserve funds
                    Comments

                    This field is only used for preauthorizations.

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

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

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

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

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

                    ShortPrior or corollary claims
                    Comments

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

                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

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

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

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

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

                    ShortAdditional content defined by implementations
                    Comments

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

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

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

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

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

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

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

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

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

                    Reference to a related claim.

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

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

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

                    A code to convey how the claims are related.

                    ShortHow the reference claim is related
                    Comments

                    For example, prior claim or umbrella.

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

                    Relationship of this claim to a related Claim.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Some insurers need a declaration of the type of relationship.

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

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

                    ShortFile or case reference
                    Comments

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

                    Control0..1
                    TypeIdentifier
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

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

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

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

                    Required to authorize the dispensing of controlled substances and devices.

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

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

                    ShortOriginal prescription if superseded by fulfiller
                    Comments

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

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

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

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

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

                    ShortRecipient of benefits payable
                    Comments

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

                    Control0..1
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

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

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

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

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

                    ShortAdditional content defined by implementations
                    Comments

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

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

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

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

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

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

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

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

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

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

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

                    A code for the party to be reimbursed.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

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

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

                    ShortRecipient reference
                    Comments

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

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

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

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

                    A reference to a referral resource.

                    ShortTreatment referral
                    Comments

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

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

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

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

                    Facility where the services were provided.

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

                    Insurance adjudication can be dependant on where services were delivered.

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

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

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

                    Common to identify the responsible and supporting practitioners.

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

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

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

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

                    ShortAdditional content defined by implementations
                    Comments

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

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

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

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

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

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

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

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

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

                    A number to uniquely identify care team entries.

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

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

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

                    Member of the team who provided the product or service.

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

                    Often a regulatory requirement to specify the responsible provider.

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

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

                    ShortIndicator of the lead practitioner
                    Comments

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

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

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

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

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

                    ShortFunction within the team
                    Comments

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

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

                    The role codes for the care team members.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

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

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

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

                    Provider professional qualifications.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

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

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

                    ShortSupporting information
                    Comments

                    Often there are multiple jurisdiction specific valuesets which are required.

                    Control1..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

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

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

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

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

                    ShortAdditional content defined by implementations
                    Comments

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

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

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

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

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

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

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

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

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

                    A number to uniquely identify supporting information entries.

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

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

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

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

                    ShortClassification of the supplied information
                    Comments

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

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

                    The valuset used for additional information category codes.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

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

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

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

                    The valuset used for additional information codes.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Required to identify the kind of additional information.

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

                    The date when or period to which this information refers.

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

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

                    ShortData to be provided
                    Comments

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

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

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

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

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

                    ShortExplanation for the information
                    Comments

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

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

                    Reason codes for the missing teeth.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

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

                    Information about diagnoses relevant to the claim items.

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

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

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

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

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

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

                    ShortAdditional content defined by implementations
                    Comments

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

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

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

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

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

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

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

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

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

                    A number to uniquely identify diagnosis entries.

                    ShortDiagnosis instance identifier
                    Comments

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

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

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

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

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

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

                    Example ICD10 Diagnostic codes.

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

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

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

                    When the condition was observed or the relative ranking.

                    ShortTiming or nature of the diagnosis
                    Comments

                    For example: admitting, primary, secondary, discharge.

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

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

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

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

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

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

                    Present on admission.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

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

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

                    ShortPackage billing code
                    Comments

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

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

                    The DRG codes associated with the diagnosis.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

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

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

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

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

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

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

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

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

                    ShortAdditional content defined by implementations
                    Comments

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

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

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

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

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

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

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

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

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

                    A number to uniquely identify procedure entries.

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

                    Necessary to provide a mechanism to link to claim details.

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

                    When the condition was observed or the relative ranking.

                    ShortCategory of Procedure
                    Comments

                    For example: primary, secondary.

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

                    Example procedure type codes.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

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

                    Date and optionally time the procedure was performed.

                    ShortWhen the procedure was performed
                    Control0..1
                    TypedateTime
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Required for auditing purposes.

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

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

                    ShortSpecific clinical procedure
                    Control1..1
                    BindingFor example codes, see ICD-10ProcedureCodes
                    (example to http://hl7.org/fhir/ValueSet/icd-10-procedures)

                    Example ICD10 Procedure codes.

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

                    This identifies the actual clinical procedure.

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

                    Unique Device Identifiers associated with this line item.

                    ShortUnique device identifier
                    Control0..*
                    TypeReference(Device)
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    The UDI code allows the insurer to obtain device level information on the product supplied.

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

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

                    ShortPatient insurance information
                    Comments

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

                    Control1..1
                    TypeBackboneElement
                    Is Modifierfalse
                    Summarytrue
                    Requirements

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

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

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

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

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

                    ShortAdditional content defined by implementations
                    Comments

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

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

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

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

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

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

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

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

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

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

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

                    To maintain order of the coverages.

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

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

                    ShortCoverage to be used for adjudication
                    Comments

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

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

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

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

                    The business identifier to be used when the claim is sent for adjudication against this insurance policy.

                    ShortPre-assigned Claim number
                    Comments

                    Only required in jurisdictions where insurers, rather than the provider, are required to send claims to insurers that appear after them in the list. This element is not required when 'subrogation=true'.

                    NoteThis is a business identifier, not a resource identifier (see discussion)
                    Control0..1
                    TypeIdentifier
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    This will be the claim number should it be necessary to create this claim in the future. This is provided so that payors may forward claims to other payors in the Coordination of Benefit for adjudication rather than the provider being required to initiate each adjudication.

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

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

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

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

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

                    A business agreement number established between the provider and the insurer for special business processing purposes.

                    ShortAdditional provider contract number
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication.

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

                    Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.

                    ShortPrior authorization reference number
                    Comments

                    This value is an alphanumeric string that may be provided over the phone, via text, via paper, or within a ClaimResponse resource and is not a FHIR Identifier.

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

                    Providers must quote previously issued authorization reference numbers in order to obtain adjudication as previously advised on the Preauthorization.

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

                    The result of the adjudication of the line items for the Coverage specified in this insurance.

                    ShortAdjudication results
                    Comments

                    Must not be specified when 'focal=true' for this insurance.

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

                    An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim.

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

                    Details of an accident which resulted in injuries which required the products and services listed in the claim.

                    ShortDetails of the event
                    Control0..1
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    When healthcare products and services are accident related, benefits may be payable under accident provisions of policies, such as automotive, etc before they are payable under normal health insurance.

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

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

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

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

                    ShortAdditional content defined by implementations
                    Comments

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

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

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

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

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

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

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

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

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

                    Date of an accident event related to the products and services contained in the claim.

                    ShortWhen the incident occurred
                    Comments

                    The date of the accident has to precede the dates of the products and services but within a reasonable timeframe.

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

                    Required for audit purposes and adjudication.

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

                    The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers.

                    ShortThe nature of the accident
                    Control0..1
                    BindingUnless not suitable, these codes SHALL be taken from ActIncidentCode
                    (extensible to http://terminology.hl7.org/ValueSet/v3-ActIncidentCode)

                    Type of accident: work place, auto, etc.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Coverage may be dependant on the type of accident.

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

                    The physical location of the accident event.

                    ShortWhere the event occurred
                    Control0..1
                    TypeChoice of: Address, Reference(Location)
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Required for audit purposes and determination of applicable insurance liability.

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

                    A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.

                    ShortProduct or service provided
                    Control1..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    The items to be processed for adjudication.

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

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

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

                    An Extension

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

                      Indicates a flag relevant to the patient for the pharmacy claim.

                      ShortPatient Flag
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(Patient Flag) (Extension Type: boolean)
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      202. Claim.item.extension:prescriberFlag
                      Slice NameprescriberFlag
                      Definition

                      Indicates a flag relevant to the prescriber for the pharmacy claim.

                      ShortPrescriber Flag
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(Prescriber Flag) (Extension Type: boolean)
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      204. Claim.item.extension:prescriptionFlag
                      Slice NameprescriptionFlag
                      Definition

                      Indicates a flag relevant to the prescription for the pharmacy claim.

                      ShortPrescription Flag
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(Prescription Flag) (Extension Type: boolean)
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      206. Claim.item.extension:doseFlag
                      Slice NamedoseFlag
                      Definition

                      Indicates a flag relevant to the dose for the pharmacy claim.

                      ShortDose Flag
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(Dose Flag) (Extension Type: boolean)
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      208. Claim.item.extension:groupId
                      Slice NamegroupId
                      Definition

                      A group identifier relevant to the pharmacy claim.

                      ShortGroup ID
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(Group ID) (Extension Type: string)
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      210. Claim.item.modifierExtension
                      Definition

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

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

                      ShortExtensions that cannot be ignored even if unrecognized
                      Comments

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

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

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

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

                      A number to uniquely identify item entries.

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

                      Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

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

                      CareTeam members related to this service or product.

                      ShortApplicable careTeam members
                      Control0..*
                      TypepositiveInt
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Requirements

                      Need to identify the individuals and their roles in the provision of the product or service.

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

                      Diagnosis applicable for this service or product.

                      ShortApplicable diagnoses
                      Control0..*
                      TypepositiveInt
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Requirements

                      Need to related the product or service to the associated diagnoses.

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

                      Procedures applicable for this service or product.

                      ShortApplicable procedures
                      Control0..*
                      TypepositiveInt
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Requirements

                      Need to provide any listed specific procedures to support the product or service being claimed.

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

                      Exceptions, special conditions and supporting information applicable for this service or product.

                      ShortApplicable exception and supporting information
                      Control0..*
                      TypepositiveInt
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Requirements

                      Need to reference the supporting information items that relate directly to this product or service.

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

                      The type of revenue or cost center providing the product and/or service.

                      ShortRevenue or cost center code
                      Control0..1
                      BindingFor example codes, see ExampleRevenueCenterCodes
                      (example to http://hl7.org/fhir/ValueSet/ex-revenue-center)

                      Codes for the revenue or cost centers supplying the service and/or products.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Requirements

                      Needed in the processing of institutional claims.

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

                      Code to identify the general type of benefits under which products and services are provided.

                      ShortBenefit classification
                      Comments

                      Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

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

                      Benefit categories such as: oral-basic, major, glasses.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Requirements

                      Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.

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

                      When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                      ShortBilling, service, product, or drug code
                      Comments

                      If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                      Control1..1
                      BindingFor example codes, see USCLSCodes
                      (example to http://hl7.org/fhir/ValueSet/service-uscls)

                      Allowable service and product codes.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Requirements

                      Necessary to state what was provided or done.

                      Alternate NamesDrug Code, Bill Code, Service Code
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      228. Claim.item.modifier
                      Definition

                      Item typification or modifiers codes to convey additional context for the product or service.

                      ShortProduct or service billing modifiers
                      Comments

                      For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.

                      Control0..*
                      BindingFor example codes, see ModifierTypeCodes
                      (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                      Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Requirements

                      To support inclusion of the item for adjudication or to charge an elevated fee.

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

                      Identifies the program under which this may be recovered.

                      ShortProgram the product or service is provided under
                      Comments

                      For example: Neonatal program, child dental program or drug users recovery program.

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

                      Program specific reason codes.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Requirements

                      Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

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

                      The date or dates when the service or product was supplied, performed or completed.

                      ShortDate or dates of service or product delivery
                      Control1..1
                      Typedate
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Requirements

                      Needed to determine whether the service or product was provided during the term of the insurance coverage.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      SlicingThis element introduces a set of slices on Claim.item.serviced[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                      • type @ $this
                      • 234. Claim.item.serviced[x]:servicedDate
                        Slice NameservicedDate
                        Definition

                        The date or dates when the service or product was supplied, performed or completed.

                        ShortDate or dates of service or product delivery
                        Control1..1
                        Typedate
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        Needed to determine whether the service or product was provided during the term of the insurance coverage.

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

                        Where the product or service was provided.

                        ShortPlace of service or where product was supplied
                        Control0..1
                        BindingFor example codes, see ExampleServicePlaceCodes
                        (example to http://hl7.org/fhir/ValueSet/service-place)

                        Place of service: pharmacy, school, prison, etc.

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

                        The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

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

                        The number of repetitions of a service or product.

                        ShortCount of products or services
                        Control0..1
                        TypeQuantity(SimpleQuantity)
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Required when the product or service code does not convey the quantity provided.

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

                        If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                        ShortFee, charge or cost per item
                        Control0..1
                        TypeMoney
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        The amount charged to the patient by the provider for a single unit.

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

                        A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                        ShortPrice scaling factor
                        Comments

                        To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

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

                        When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

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

                        The quantity times the unit price for an additional service or product or charge.

                        ShortTotal item cost
                        Comments

                        For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                        Control0..1
                        TypeMoney
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Provides the total amount claimed for the group (if a grouper) or the line item.

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

                        Unique Device Identifiers associated with this line item.

                        ShortUnique device identifier
                        Control0..*
                        TypeReference(Device)
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        The UDI code allows the insurer to obtain device level information on the product supplied.

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

                        Physical service site on the patient (limb, tooth, etc.).

                        ShortAnatomical location
                        Comments

                        For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.

                        Control0..1
                        BindingFor example codes, see OralSiteCodes
                        (example to http://hl7.org/fhir/ValueSet/tooth)

                        The code for the teeth, quadrant, sextant and arch.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Allows insurer to validate specific procedures.

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

                        A region or surface of the bodySite, e.g. limb region or tooth surface(s).

                        ShortAnatomical sub-location
                        Control0..*
                        BindingFor example codes, see SurfaceCodes
                        (example to http://hl7.org/fhir/ValueSet/surface)

                        The code for the tooth surface and surface combinations.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Allows insurer to validate specific procedures.

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

                        The Encounters during which this Claim was created or to which the creation of this record is tightly associated.

                        ShortEncounters related to this billed item
                        Comments

                        This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

                        Control0..*
                        TypeReference(Encounter)
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Used in some jurisdictions to link clinical events to claim items.

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

                        A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.

                        ShortProduct or service provided
                        Control1..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        The items to be processed for adjudication.

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

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

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

                        An Extension

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

                          Indicates the balance owing for the pharmacy claim item detail.

                          ShortBalance Owing
                          Control0..1
                          This element is affected by the following invariants: ele-1
                          TypeExtension(Balance Owing) (Extension Type: string)
                          Is Modifierfalse
                          Summaryfalse
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          262. Claim.item.detail.extension:wastageQuantity
                          Slice NamewastageQuantity
                          Definition

                          Indicates the wastage quantity for the pharmacy claim item detail.

                          ShortWastage Quantity
                          Control0..1
                          This element is affected by the following invariants: ele-1
                          TypeExtension(Wastage Quantity) (Extension Type: Quantity)
                          Is Modifierfalse
                          Summaryfalse
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          264. Claim.item.detail.extension:cbsSubsidy
                          Slice NamecbsSubsidy
                          Definition

                          Indicates the CBS subsidy for the pharmacy claim item detail.

                          ShortCBS Subsidy
                          Control0..1
                          This element is affected by the following invariants: ele-1
                          TypeExtension(CBS Subsidy) (Extension Type: Money)
                          Is Modifierfalse
                          Summaryfalse
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          266. Claim.item.detail.extension:cbsPackSize
                          Slice NamecbsPackSize
                          Definition

                          Indicates the CBS pack size for the pharmacy claim item detail.

                          ShortCBS Pack Size
                          Control0..1
                          This element is affected by the following invariants: ele-1
                          TypeExtension(CBS Pack Size) (Extension Type: Quantity)
                          Is Modifierfalse
                          Summaryfalse
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          268. Claim.item.detail.modifierExtension
                          Definition

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

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

                          ShortExtensions that cannot be ignored even if unrecognized
                          Comments

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

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

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

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

                          A number to uniquely identify item entries.

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

                          Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          272. Claim.item.detail.revenue
                          Definition

                          The type of revenue or cost center providing the product and/or service.

                          ShortRevenue or cost center code
                          Control0..1
                          BindingFor example codes, see ExampleRevenueCenterCodes
                          (example to http://hl7.org/fhir/ValueSet/ex-revenue-center)

                          Codes for the revenue or cost centers supplying the service and/or products.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Needed in the processing of institutional claims.

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

                          Code to identify the general type of benefits under which products and services are provided.

                          ShortBenefit classification
                          Comments

                          Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

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

                          Benefit categories such as: oral-basic, major, glasses.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          276. Claim.item.detail.productOrService
                          Definition

                          When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                          ShortBilling, service, product, or drug code
                          Comments

                          If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                          Control1..1
                          BindingFor example codes, see USCLSCodes
                          (example to http://hl7.org/fhir/ValueSet/service-uscls)

                          Allowable service and product codes.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Necessary to state what was provided or done.

                          Alternate NamesDrug Code, Bill Code, Service Code
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          278. Claim.item.detail.modifier
                          Definition

                          Item typification or modifiers codes to convey additional context for the product or service.

                          ShortService/Product billing modifiers
                          Comments

                          For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

                          Control0..*
                          BindingFor example codes, see ModifierTypeCodes
                          (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                          Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          To support inclusion of the item for adjudication or to charge an elevated fee.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          280. Claim.item.detail.programCode
                          Definition

                          Identifies the program under which this may be recovered.

                          ShortProgram the product or service is provided under
                          Comments

                          For example: Neonatal program, child dental program or drug users recovery program.

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

                          Program specific reason codes.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          282. Claim.item.detail.quantity
                          Definition

                          The number of repetitions of a service or product.

                          ShortCount of products or services
                          Control1..1
                          TypeQuantity(SimpleQuantity)
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Required when the product or service code does not convey the quantity provided.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          284. Claim.item.detail.unitPrice
                          Definition

                          If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                          ShortFee, charge or cost per item
                          Control0..1
                          TypeMoney
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          The amount charged to the patient by the provider for a single unit.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          286. Claim.item.detail.factor
                          Definition

                          A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                          ShortPrice scaling factor
                          Comments

                          To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

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

                          When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          288. Claim.item.detail.net
                          Definition

                          The quantity times the unit price for an additional service or product or charge.

                          ShortTotal item cost
                          Comments

                          For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                          Control1..1
                          TypeMoney
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Provides the total amount claimed for the group (if a grouper) or the line item.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          290. Claim.item.detail.udi
                          Definition

                          Unique Device Identifiers associated with this line item.

                          ShortUnique device identifier
                          Control0..*
                          TypeReference(Device)
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          The UDI code allows the insurer to obtain device level information on the product supplied.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          292. Claim.item.detail.subDetail
                          Definition

                          A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.

                          ShortProduct or service provided
                          Control0..*
                          TypeBackboneElement
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          The items to be processed for adjudication.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          294. Claim.item.detail.subDetail.id
                          Definition

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

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

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

                          ShortAdditional content defined by implementations
                          Comments

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

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

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

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

                          ShortExtensions that cannot be ignored even if unrecognized
                          Comments

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

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

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

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

                          A number to uniquely identify item entries.

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

                          Necessary to provide a mechanism to link to items from within the claim and within the adjudication details of the ClaimResponse.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          302. Claim.item.detail.subDetail.revenue
                          Definition

                          The type of revenue or cost center providing the product and/or service.

                          ShortRevenue or cost center code
                          Control0..1
                          BindingFor example codes, see ExampleRevenueCenterCodes
                          (example to http://hl7.org/fhir/ValueSet/ex-revenue-center)

                          Codes for the revenue or cost centers supplying the service and/or products.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Needed in the processing of institutional claims.

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

                          Code to identify the general type of benefits under which products and services are provided.

                          ShortBenefit classification
                          Comments

                          Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.

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

                          Benefit categories such as: oral-basic, major, glasses.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Needed in the processing of institutional claims as this allows the insurer to determine whether a facial X-Ray is for dental, orthopedic, or facial surgery purposes.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          306. Claim.item.detail.subDetail.productOrService
                          Definition

                          When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                          ShortBilling, service, product, or drug code
                          Comments

                          If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                          Control1..1
                          BindingFor example codes, see USCLSCodes
                          (example to http://hl7.org/fhir/ValueSet/service-uscls)

                          Allowable service and product codes.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Necessary to state what was provided or done.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          308. Claim.item.detail.subDetail.modifier
                          Definition

                          Item typification or modifiers codes to convey additional context for the product or service.

                          ShortService/Product billing modifiers
                          Comments

                          For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.

                          Control0..*
                          BindingFor example codes, see ModifierTypeCodes
                          (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                          Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          To support inclusion of the item for adjudication or to charge an elevated fee.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          310. Claim.item.detail.subDetail.programCode
                          Definition

                          Identifies the program under which this may be recovered.

                          ShortProgram the product or service is provided under
                          Comments

                          For example: Neonatal program, child dental program or drug users recovery program.

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

                          Program specific reason codes.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          312. Claim.item.detail.subDetail.quantity
                          Definition

                          The number of repetitions of a service or product.

                          ShortCount of products or services
                          Control0..1
                          TypeQuantity(SimpleQuantity)
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Required when the product or service code does not convey the quantity provided.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          314. Claim.item.detail.subDetail.unitPrice
                          Definition

                          If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                          ShortFee, charge or cost per item
                          Control0..1
                          TypeMoney
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          The amount charged to the patient by the provider for a single unit.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          316. Claim.item.detail.subDetail.factor
                          Definition

                          A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                          ShortPrice scaling factor
                          Comments

                          To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

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

                          When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          318. Claim.item.detail.subDetail.net
                          Definition

                          The quantity times the unit price for an additional service or product or charge.

                          ShortTotal item cost
                          Comments

                          For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                          Control0..1
                          TypeMoney
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Provides the total amount claimed for the group (if a grouper) or the line item.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          320. Claim.item.detail.subDetail.udi
                          Definition

                          Unique Device Identifiers associated with this line item.

                          ShortUnique device identifier
                          Control0..*
                          TypeReference(Device)
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          The UDI code allows the insurer to obtain device level information on the product supplied.

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

                          The total value of the all the items in the claim.

                          ShortTotal claim cost
                          Control1..1
                          TypeMoney
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Used for control total purposes.

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