Health New Zealand Te Whatu Ora Shared Care FHIR API - Local Development build (v0.4.7) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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Resource Profile: NZ Pharmacy Claim

A FHIR resource profile for NZ Pharmacy Claims, including extensions for patient cohort and claimant information.

This profile is used to represent pharmacy claims in New Zealand, including patient cohort information and claimant details.

Usages:

• Examples for this Profile: Claim/NzPharmacyClaimExample2
• CapabilityStatements using this Profile: Shared Care FHIR Server Capability Statement

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
Claim.meta	Σ This element is included in summaries.	1..1	Meta	Metadata about the resource
Claim.meta.source	Σ This element is included in summaries. C	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
Claim.meta.profile	Σ This element is included in summaries.	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Claim.meta.Slices for tag	Σ This element is included in summaries.	1..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.meta.Slices for tag.tag:correlationId	Σ This element is included in summaries.	1..1	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
Claim.meta.Slices for tag.tag:correlationId.system	Σ This element is included in summaries.	1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
Claim.meta.Slices for tag.tag:correlationId.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Claim.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for extension.extension:patientCohort		0..1	CodeableConcept	Patient Cohort URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort Binding: Patient Cohort ValueSet (required)
Claim.Slices for extension.extension:claimantNumber		1..1	string	Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number
Claim.Slices for extension.extension:originatingClaimantNumber		0..1	string	Originating Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number
Claim.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.identifier		1..*	Identifier	Business Identifier for claim
Claim.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Claim.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
Claim.identifier.value	Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
Claim.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Claim.type	Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: NZ Claim Types (extensible)
Claim.subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
Claim.use	Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Claim.patient	Σ This element is included in summaries.	1..1	Reference(NZ Patient | Patient)	The recipient of the products and services
Claim.patient.type	Σ This element is included in summaries.	1..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). Required Pattern: Patient
Claim.patient.identifier	Σ This element is included in summaries.	1..1	Identifier	Logical reference, when literal reference is not known
Claim.patient.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Claim.patient.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/nhi-id
Claim.patient.identifier.value	Σ This element is included in summaries. C	1..1	string	Must be an absolute URL reference to the patient on the NHI system. See constraints for details. Constraints: nhi-value-format Example General: 123456
Claim.billablePeriod	Σ This element is included in summaries.	1..1	Period	Relevant time frame for the claim
Claim.billablePeriod.start	Σ This element is included in summaries. C	1..1	dateTime	Starting time with inclusive boundary Constraints: date-only
Claim.billablePeriod.end	Σ This element is included in summaries. C	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: date-only
Claim.created	Σ This element is included in summaries. C	1..1	dateTime	Resource creation date Constraints: full-datetime-with-timezone
Claim.provider	Σ This element is included in summaries.	1..1	Reference(Organization)	Party responsible for the claim
Claim.provider.identifier	Σ This element is included in summaries. C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
Claim.provider.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Claim.provider.identifier.system	Σ This element is included in summaries. C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
Claim.provider.identifier.value	Σ This element is included in summaries.	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
Claim.priority	Σ This element is included in summaries.	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
Claim.insurance	Σ This element is included in summaries.	1..1	BackboneElement	Patient insurance information
Claim.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence	Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier
Claim.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication
Claim.insurance.coverage	Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Claim.item		1..*	BackboneElement	Product or service provided
Claim.item.Slices for extension		3..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for extension.extension:patientFlag		0..1	boolean	Patient Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag
Claim.item.Slices for extension.extension:request		1..1	(Complex)	Item Request URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request
Claim.item.Slices for extension.extension:request.extension		0..0		Extension Slice: Unordered, Open by value:url
Claim.item.Slices for extension.extension:request.url		1..1	uri	"https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request"
Claim.item.Slices for extension.extension:request.value[x]		1..1	Reference(NZ Medication Dispense)	Value of extension
Claim.item.Slices for extension.extension:prescriberFlag		0..1	boolean	Prescriber Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag
Claim.item.Slices for extension.extension:prescriptionFlag		0..1	boolean	Prescription Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag
Claim.item.Slices for extension.extension:doseFlag		0..1	boolean	Dose Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag
Claim.item.Slices for extension.extension:groupId		0..1	string	Group ID URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id
Claim.item.Slices for extension.extension:transactionCategory		1..1	CodeableConcept	Transaction Category URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/transaction-category Binding: NZ Pharmacy Transaction Category (required)
Claim.item.Slices for extension.extension:extendedSupplyFlag		0..1	boolean	Extended Supply Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/extended-supply-flag
Claim.item.Slices for extension.extension:classification		0..1	(Complex)	Classification Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification
Claim.item.Slices for extension.extension:classification.extension		0..0		Extension Slice: Unordered, Open by value:url
Claim.item.Slices for extension.extension:classification.url		1..1	uri	"https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification"
Claim.item.Slices for extension.extension:classification.value[x]		0..1	CodeableConcept	Value of extension Binding: NZ Pharmacy Claim Item Classification (required)
Claim.item.Slices for extension.extension:pscFlag		1..1	boolean	PSC Flag Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/psc-flag
Claim.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.sequence		1..1	positiveInt	Item instance identifier
Claim.item.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.Slices for serviced[x]		1..1	Period	Date or dates of service or product delivery Slice: Unordered, Closed by type:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod		1..1	Period	Date or dates of service or product delivery
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.start	Σ This element is included in summaries. C	1..1	dateTime	Starting time with inclusive boundary Constraints: full-datetime-with-timezone
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.end	Σ This element is included in summaries. C	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: full-datetime-with-timezone
Claim.item.detail		1..*	BackboneElement	Product or service provided
Claim.item.detail.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.detail.Slices for extension.extension:balanceOwing		0..1	string	Balance Owing URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing
Claim.item.detail.Slices for extension.extension:wastageQuantity		0..1	Quantity	Wastage Quantity URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity
Claim.item.detail.Slices for extension.extension:cbsSubsidy		0..1	Money	CBS Subsidy URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy
Claim.item.detail.Slices for extension.extension:cbsPackSize		0..1	Quantity	CBS Pack Size URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize
Claim.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.quantity	C	1..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.detail.net		1..1	Money	Total item cost
Claim.total		1..1	Money	Total claim cost
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.meta.tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
Claim.meta.tag:correlationId	Base	example	Common Tags	📍4.0.1	FHIR Std.
Claim.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	NZ Claim Types	📦0.4.7	This IG
Claim.subType	Base	extensible	NZ Claim Subtypes	📦0.4.7	This IG
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.patient.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.patient.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.provider.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.priority	Base	required	Process Priority Codes	📦4.0.1	FHIR Std.
Claim.payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.item.extension:classification.​value[x]	Base	required	NZ Pharmacy Claim Item Classification	📦0.4.7	This IG
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
allowedLocalIdentifierSystems	error	Claim.provider.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN	$this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
date-only	error	Claim.billablePeriod.start, Claim.billablePeriod.end	DateTime must be date-only in yyyy-mm-dd format. Time and timezone values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}$')
full-datetime-with-timezone	error	Claim.created, Claim.item.serviced[x]:servicedPeriod.start, Claim.item.serviced[x]:servicedPeriod.end	DateTime must be ISO 8601 format with time and timezone (e.g., 2026-01-01T00:00:00+13:00 or 2026-01-01T00:00:00Z). Date-only values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}T[0-9]{2}:[0-9]{2}:[0-9]{2}(\\.[0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
hpi-location-url-format	error	Claim.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A	matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	Claim.provider.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic).	system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	Claim.provider.identifier	HPI Facility ID must conform to format (FXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	Claim.provider.identifier	HPI Organisation ID must conform to format (GXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
nhi-value-format	error	Claim.patient.identifier.value	Reference must be an NHI Patient URL with format ZZZ1111 or ZZZ11AA	matches('^[A-Z]{3}([0-9]{4}|[0-9]{2}[A-Z]{2})$')
nzbnPattern	error	Claim.provider.identifier	NZBN must conform to format (13 digits).	system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
Claim.meta		1..1	Meta	Metadata about the resource
Claim.meta.source	C	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
Claim.meta.profile		1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Claim.meta.Slices for tag		1..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.meta.Slices for tag.tag:correlationId		1..1	Coding	Tags applied to this resource
Claim.meta.Slices for tag.tag:correlationId.system		1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
Claim.meta.Slices for tag.tag:correlationId.code		1..1	code	Symbol in syntax defined by the system
Claim.contained		0..0		Contained, inline Resources
Claim.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for extension.extension:patientCohort		0..1	CodeableConcept	Patient Cohort URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort Binding: Patient Cohort ValueSet (required)
Claim.Slices for extension.extension:claimantNumber		1..1	string	Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number
Claim.Slices for extension.extension:originatingClaimantNumber		0..1	string	Originating Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number
Claim.identifier		1..*	Identifier	Business Identifier for claim
Claim.identifier.system		1..1	uri	The namespace for the identifier value
Claim.identifier.value		1..1	string	The value that is unique
Claim.type		1..1	CodeableConcept	Category or discipline Binding: NZ Claim Types (extensible)
Claim.subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
Claim.patient		1..1	Reference(NZ Patient | Patient)	The recipient of the products and services
Claim.patient.type		1..1	uri	Type the reference refers to (e.g. "Patient") Required Pattern: Patient
Claim.patient.identifier		1..1	Identifier	Logical reference, when literal reference is not known
Claim.patient.identifier.system		1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/nhi-id
Claim.patient.identifier.value	C	1..1	string	Must be an absolute URL reference to the patient on the NHI system. See constraints for details. Constraints: nhi-value-format
Claim.patient.display		0..0		Text alternative for the resource
Claim.billablePeriod		1..1	Period	Relevant time frame for the claim
Claim.billablePeriod.start	C	1..1	dateTime	Starting time with inclusive boundary Constraints: date-only
Claim.billablePeriod.end	C	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: date-only
Claim.created	C	1..1	dateTime	Resource creation date Constraints: full-datetime-with-timezone
Claim.insurer		0..0		Target
Claim.provider		1..1	Reference(Organization)	Party responsible for the claim
Claim.provider.identifier	C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
Claim.provider.identifier.use		0..1	code	The local identifier use SHOULD be set to official.
Claim.provider.identifier.system	C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
Claim.provider.identifier.value		1..1	string	The actual local identifier value, e.g. GZZ999-Z Example Example HPI Org ID: GZZ999-Z
Claim.priority		1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
Claim.fundsReserve		0..0		For whom to reserve funds
Claim.prescription		0..0		Prescription authorizing services and products
Claim.originalPrescription		0..0		Original prescription if superseded by fulfiller
Claim.payee		0..0		Recipient of benefits payable
Claim.careTeam		0..0		Members of the care team
Claim.diagnosis		0..0		Pertinent diagnosis information
Claim.procedure		0..0		Clinical procedures performed
Claim.insurance		1..1	BackboneElement	Patient insurance information
Claim.accident		0..0		Details of the event
Claim.item		1..*	BackboneElement	Product or service provided
Claim.item.Slices for extension		3..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for extension.extension:patientFlag		0..1	boolean	Patient Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag
Claim.item.Slices for extension.extension:request		1..1	(Complex)	Item Request URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request
Claim.item.Slices for extension.extension:request.value[x]		1..1	Reference(NZ Medication Dispense)	Value of extension
Claim.item.Slices for extension.extension:prescriberFlag		0..1	boolean	Prescriber Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag
Claim.item.Slices for extension.extension:prescriptionFlag		0..1	boolean	Prescription Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag
Claim.item.Slices for extension.extension:doseFlag		0..1	boolean	Dose Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag
Claim.item.Slices for extension.extension:groupId		0..1	string	Group ID URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id
Claim.item.Slices for extension.extension:transactionCategory		1..1	CodeableConcept	Transaction Category URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/transaction-category Binding: NZ Pharmacy Transaction Category (required)
Claim.item.Slices for extension.extension:extendedSupplyFlag		0..1	boolean	Extended Supply Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/extended-supply-flag
Claim.item.Slices for extension.extension:classification		0..1	(Complex)	Classification Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification
Claim.item.Slices for extension.extension:classification.value[x]		0..1	CodeableConcept	Value of extension Binding: NZ Pharmacy Claim Item Classification (required)
Claim.item.Slices for extension.extension:pscFlag		1..1	boolean	PSC Flag Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/psc-flag
Claim.item.revenue		0..0		Revenue or cost center code
Claim.item.category		0..0		Benefit classification
Claim.item.modifier		0..0		Product or service billing modifiers
Claim.item.programCode		0..0		Program the product or service is provided under
Claim.item.Slices for serviced[x]		1..1	Period	Date or dates of service or product delivery Slice: Unordered, Open by type:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod		1..1	Period	Date or dates of service or product delivery
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.start	C	1..1	dateTime	Starting time with inclusive boundary Constraints: full-datetime-with-timezone
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.end	C	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: full-datetime-with-timezone
Claim.item.udi		0..0		Unique device identifier
Claim.item.bodySite		0..0		Anatomical location
Claim.item.subSite		0..0		Anatomical sub-location
Claim.item.detail		1..*	BackboneElement	Product or service provided
Claim.item.detail.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.detail.Slices for extension.extension:balanceOwing		0..1	string	Balance Owing URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing
Claim.item.detail.Slices for extension.extension:wastageQuantity		0..1	Quantity	Wastage Quantity URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity
Claim.item.detail.Slices for extension.extension:cbsSubsidy		0..1	Money	CBS Subsidy URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy
Claim.item.detail.Slices for extension.extension:cbsPackSize		0..1	Quantity	CBS Pack Size URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize
Claim.item.detail.revenue		0..0		Revenue or cost center code
Claim.item.detail.category		0..0		Benefit classification
Claim.item.detail.modifier		0..0		Service/Product billing modifiers
Claim.item.detail.programCode		0..0		Program the product or service is provided under
Claim.item.detail.quantity		1..1	SimpleQuantity(4.0.1)	Count of products or services
Claim.item.detail.net		1..1	Money	Total item cost
Claim.item.detail.udi		0..0		Unique device identifier
Claim.total		1..1	Money	Total claim cost
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Claim.type	Base	extensible	NZ Claim Types	📦0.4.7	This IG
Claim.subType	Base	extensible	NZ Claim Subtypes	📦0.4.7	This IG
Claim.priority	Base	required	Process Priority Codes	📦4.0.1	FHIR Std.
Claim.item.extension:classification.​value[x]	Base	required	NZ Pharmacy Claim Item Classification	📦0.4.7	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
allowedLocalIdentifierSystems	error	Claim.provider.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN	$this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
date-only	error	Claim.billablePeriod.start, Claim.billablePeriod.end	DateTime must be date-only in yyyy-mm-dd format. Time and timezone values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}$')
full-datetime-with-timezone	error	Claim.created, Claim.item.serviced[x]:servicedPeriod.start, Claim.item.serviced[x]:servicedPeriod.end	DateTime must be ISO 8601 format with time and timezone (e.g., 2026-01-01T00:00:00+13:00 or 2026-01-01T00:00:00Z). Date-only values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}T[0-9]{2}:[0-9]{2}:[0-9]{2}(\\.[0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
hpi-location-url-format	error	Claim.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A	matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	Claim.provider.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic).	system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	Claim.provider.identifier	HPI Facility ID must conform to format (FXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	Claim.provider.identifier	HPI Organisation ID must conform to format (GXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
nhi-value-format	error	Claim.patient.identifier.value	Reference must be an NHI Patient URL with format ZZZ1111 or ZZZ11AA	matches('^[A-Z]{3}([0-9]{4}|[0-9]{2}[A-Z]{2})$')
nzbnPattern	error	Claim.provider.identifier	NZBN must conform to format (13 digits).	system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
Claim.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
Claim.meta	Σ This element is included in summaries.	1..1	Meta	Metadata about the resource
Claim.meta.id		0..1	string	Unique id for inter-element referencing
Claim.meta.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.meta.versionId	Σ This element is included in summaries.	0..1	id	Version specific identifier
Claim.meta.lastUpdated	Σ This element is included in summaries.	0..1	instant	When the resource version last changed
Claim.meta.source	Σ This element is included in summaries. C	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
Claim.meta.profile	Σ This element is included in summaries.	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Claim.meta.security	Σ This element is included in summaries.	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Claim.meta.Slices for tag	Σ This element is included in summaries.	1..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.meta.Slices for tag.tag:correlationId	Σ This element is included in summaries.	1..1	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
Claim.meta.Slices for tag.tag:correlationId.id		0..1	string	Unique id for inter-element referencing
Claim.meta.Slices for tag.tag:correlationId.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.meta.Slices for tag.tag:correlationId.system	Σ This element is included in summaries.	1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
Claim.meta.Slices for tag.tag:correlationId.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.meta.Slices for tag.tag:correlationId.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.meta.Slices for tag.tag:correlationId.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.meta.Slices for tag.tag:correlationId.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Claim.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Claim.text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Claim.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for extension.extension:patientCohort		0..1	CodeableConcept	Patient Cohort URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort Binding: Patient Cohort ValueSet (required)
Claim.Slices for extension.extension:claimantNumber		1..1	string	Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number
Claim.Slices for extension.extension:originatingClaimantNumber		0..1	string	Originating Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number
Claim.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.identifier		1..*	Identifier	Business Identifier for claim
Claim.identifier.id		0..1	string	Unique id for inter-element referencing
Claim.identifier.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Claim.identifier.type	Σ This element is included in summaries.	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Claim.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
Claim.identifier.value	Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
Claim.identifier.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
Claim.identifier.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
Claim.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Claim.type	Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: NZ Claim Types (extensible)
Claim.subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
Claim.use	Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Claim.patient	Σ This element is included in summaries.	1..1	Reference(NZ Patient | Patient)	The recipient of the products and services
Claim.patient.id		0..1	string	Unique id for inter-element referencing
Claim.patient.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.patient.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
Claim.patient.type	Σ This element is included in summaries.	1..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). Required Pattern: Patient
Claim.patient.identifier	Σ This element is included in summaries.	1..1	Identifier	Logical reference, when literal reference is not known
Claim.patient.identifier.id		0..1	string	Unique id for inter-element referencing
Claim.patient.identifier.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.patient.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Claim.patient.identifier.type	Σ This element is included in summaries.	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Claim.patient.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/nhi-id
Claim.patient.identifier.value	Σ This element is included in summaries. C	1..1	string	Must be an absolute URL reference to the patient on the NHI system. See constraints for details. Constraints: nhi-value-format Example General: 123456
Claim.patient.identifier.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
Claim.patient.identifier.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
Claim.billablePeriod	Σ This element is included in summaries.	1..1	Period	Relevant time frame for the claim
Claim.billablePeriod.id		0..1	string	Unique id for inter-element referencing
Claim.billablePeriod.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.billablePeriod.start	Σ This element is included in summaries. C	1..1	dateTime	Starting time with inclusive boundary Constraints: date-only
Claim.billablePeriod.end	Σ This element is included in summaries. C	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: date-only
Claim.created	Σ This element is included in summaries. C	1..1	dateTime	Resource creation date Constraints: full-datetime-with-timezone
Claim.enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
Claim.provider	Σ This element is included in summaries.	1..1	Reference(Organization)	Party responsible for the claim
Claim.provider.id		0..1	string	Unique id for inter-element referencing
Claim.provider.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.provider.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
Claim.provider.type	Σ This element is included in summaries.	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
Claim.provider.identifier	Σ This element is included in summaries. C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
Claim.provider.identifier.id		0..1	string	Unique id for inter-element referencing
Claim.provider.identifier.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.provider.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Claim.provider.identifier.type	Σ This element is included in summaries.	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Claim.provider.identifier.system	Σ This element is included in summaries. C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
Claim.provider.identifier.value	Σ This element is included in summaries.	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
Claim.provider.identifier.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
Claim.provider.identifier.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
Claim.provider.display	Σ This element is included in summaries.	0..1	string	Text alternative for the resource
Claim.priority	Σ This element is included in summaries.	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
Claim.related		0..*	BackboneElement	Prior or corollary claims
Claim.related.id		0..1	string	Unique id for inter-element referencing
Claim.related.extension		0..*	Extension	Additional content defined by implementations
Claim.related.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.related.claim		0..1	Reference(Claim)	Reference to the related claim
Claim.related.relationship		0..1	CodeableConcept	How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
Claim.related.reference		0..1	Identifier	File or case reference
Claim.referral		0..1	Reference(ServiceRequest)	Treatment referral
Claim.facility		0..1	Reference(Location)	Servicing facility
Claim.supportingInfo		0..*	BackboneElement	Supporting information
Claim.supportingInfo.id		0..1	string	Unique id for inter-element referencing
Claim.supportingInfo.extension		0..*	Extension	Additional content defined by implementations
Claim.supportingInfo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.supportingInfo.sequence		1..1	positiveInt	Information instance identifier
Claim.supportingInfo.category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.supportingInfo.code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.supportingInfo.timing[x]		0..1		When it occurred
Claim.supportingInfo.timing[x].timingDate			date
Claim.supportingInfo.timing[x].timingPeriod			Period
Claim.supportingInfo.value[x]		0..1		Data to be provided
Claim.supportingInfo.value[x].valueBoolean			boolean
Claim.supportingInfo.value[x].valueString			string
Claim.supportingInfo.value[x].valueQuantity			Quantity
Claim.supportingInfo.value[x].valueAttachment			Attachment
Claim.supportingInfo.value[x].valueReference			Reference(Resource)
Claim.supportingInfo.reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.insurance	Σ This element is included in summaries.	1..1	BackboneElement	Patient insurance information
Claim.insurance.id		0..1	string	Unique id for inter-element referencing
Claim.insurance.extension		0..*	Extension	Additional content defined by implementations
Claim.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence	Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier
Claim.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication
Claim.insurance.identifier		0..1	Identifier	Pre-assigned Claim number
Claim.insurance.coverage	Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Claim.insurance.businessArrangement		0..1	string	Additional provider contract number
Claim.insurance.preAuthRef		0..*	string	Prior authorization reference number
Claim.insurance.claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
Claim.item		1..*	BackboneElement	Product or service provided
Claim.item.id		0..1	string	Unique id for inter-element referencing
Claim.item.Slices for extension		3..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for extension.extension:patientFlag		0..1	boolean	Patient Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag
Claim.item.Slices for extension.extension:request		1..1	(Complex)	Item Request URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request
Claim.item.Slices for extension.extension:request.id		0..1	string	Unique id for inter-element referencing
Claim.item.Slices for extension.extension:request.extension		0..0		Extension Slice: Unordered, Open by value:url
Claim.item.Slices for extension.extension:request.url		1..1	uri	"https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request"
Claim.item.Slices for extension.extension:request.value[x]		1..1	Reference(NZ Medication Dispense)	Value of extension
Claim.item.Slices for extension.extension:prescriberFlag		0..1	boolean	Prescriber Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag
Claim.item.Slices for extension.extension:prescriptionFlag		0..1	boolean	Prescription Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag
Claim.item.Slices for extension.extension:doseFlag		0..1	boolean	Dose Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag
Claim.item.Slices for extension.extension:groupId		0..1	string	Group ID URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id
Claim.item.Slices for extension.extension:transactionCategory		1..1	CodeableConcept	Transaction Category URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/transaction-category Binding: NZ Pharmacy Transaction Category (required)
Claim.item.Slices for extension.extension:extendedSupplyFlag		0..1	boolean	Extended Supply Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/extended-supply-flag
Claim.item.Slices for extension.extension:classification		0..1	(Complex)	Classification Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification
Claim.item.Slices for extension.extension:classification.id		0..1	string	Unique id for inter-element referencing
Claim.item.Slices for extension.extension:classification.extension		0..0		Extension Slice: Unordered, Open by value:url
Claim.item.Slices for extension.extension:classification.url		1..1	uri	"https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification"
Claim.item.Slices for extension.extension:classification.value[x]		0..1	CodeableConcept	Value of extension Binding: NZ Pharmacy Claim Item Classification (required)
Claim.item.Slices for extension.extension:pscFlag		1..1	boolean	PSC Flag Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/psc-flag
Claim.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.sequence		1..1	positiveInt	Item instance identifier
Claim.item.careTeamSequence		0..*	positiveInt	Applicable careTeam members
Claim.item.diagnosisSequence		0..*	positiveInt	Applicable diagnoses
Claim.item.procedureSequence		0..*	positiveInt	Applicable procedures
Claim.item.informationSequence		0..*	positiveInt	Applicable exception and supporting information
Claim.item.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.Slices for serviced[x]		1..1	Period	Date or dates of service or product delivery Slice: Unordered, Closed by type:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod		1..1	Period	Date or dates of service or product delivery
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.id		0..1	string	Unique id for inter-element referencing
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.start	Σ This element is included in summaries. C	1..1	dateTime	Starting time with inclusive boundary Constraints: full-datetime-with-timezone
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.end	Σ This element is included in summaries. C	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: full-datetime-with-timezone
Claim.item.location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
Claim.item.location[x].locationCodeableConcept			CodeableConcept
Claim.item.location[x].locationAddress			Address
Claim.item.location[x].locationReference			Reference(Location)
Claim.item.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.factor		0..1	decimal	Price scaling factor
Claim.item.net		0..1	Money	Total item cost
Claim.item.encounter		0..*	Reference(Encounter)	Encounters related to this billed item
Claim.item.detail		1..*	BackboneElement	Product or service provided
Claim.item.detail.id		0..1	string	Unique id for inter-element referencing
Claim.item.detail.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.detail.Slices for extension.extension:balanceOwing		0..1	string	Balance Owing URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing
Claim.item.detail.Slices for extension.extension:wastageQuantity		0..1	Quantity	Wastage Quantity URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity
Claim.item.detail.Slices for extension.extension:cbsSubsidy		0..1	Money	CBS Subsidy URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy
Claim.item.detail.Slices for extension.extension:cbsPackSize		0..1	Quantity	CBS Pack Size URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize
Claim.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.quantity	C	1..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.detail.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.detail.factor		0..1	decimal	Price scaling factor
Claim.item.detail.net		1..1	Money	Total item cost
Claim.item.detail.subDetail		0..*	BackboneElement	Product or service provided
Claim.item.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
Claim.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
Claim.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.subDetail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.subDetail.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.detail.subDetail.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.subDetail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.subDetail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.detail.subDetail.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.detail.subDetail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.detail.subDetail.factor		0..1	decimal	Price scaling factor
Claim.item.detail.subDetail.net		0..1	Money	Total item cost
Claim.item.detail.subDetail.udi		0..*	Reference(Device)	Unique device identifier
Claim.total		1..1	Money	Total claim cost
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.meta.security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
Claim.meta.tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
Claim.meta.tag:correlationId	Base	example	Common Tags	📍4.0.1	FHIR Std.
Claim.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Claim.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.identifier.type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	NZ Claim Types	📦0.4.7	This IG
Claim.subType	Base	extensible	NZ Claim Subtypes	📦0.4.7	This IG
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.patient.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.patient.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.patient.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Claim.provider.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.provider.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.provider.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Claim.priority	Base	required	Process Priority Codes	📦4.0.1	FHIR Std.
Claim.related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.0.1	FHIR Std.
Claim.payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
Claim.careTeam.role	Base	example	Claim Care Team Role Codes	📍4.0.1	FHIR Std.
Claim.careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.0.1	FHIR Std.
Claim.procedure.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.accident.type	Base	extensible	ActIncidentCode	📦3.0.0	THO v6.5
Claim.item.extension:classification.​value[x]	Base	required	NZ Pharmacy Claim Item Classification	📦0.4.7	This IG
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
allowedLocalIdentifierSystems	error	Claim.provider.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN	$this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
date-only	error	Claim.billablePeriod.start, Claim.billablePeriod.end	DateTime must be date-only in yyyy-mm-dd format. Time and timezone values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}$')
full-datetime-with-timezone	error	Claim.created, Claim.item.serviced[x]:servicedPeriod.start, Claim.item.serviced[x]:servicedPeriod.end	DateTime must be ISO 8601 format with time and timezone (e.g., 2026-01-01T00:00:00+13:00 or 2026-01-01T00:00:00Z). Date-only values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}T[0-9]{2}:[0-9]{2}:[0-9]{2}(\\.[0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
hpi-location-url-format	error	Claim.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A	matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	Claim.provider.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic).	system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	Claim.provider.identifier	HPI Facility ID must conform to format (FXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	Claim.provider.identifier	HPI Organisation ID must conform to format (GXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
nhi-value-format	error	Claim.patient.identifier.value	Reference must be an NHI Patient URL with format ZZZ1111 or ZZZ11AA	matches('^[A-Z]{3}([0-9]{4}|[0-9]{2}[A-Z]{2})$')
nzbnPattern	error	Claim.provider.identifier	NZBN must conform to format (13 digits).	system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

This structure is derived from Claim

Summary

Mandatory: 35 elements
Fixed: 1 element
Prohibited: 23 elements

Structures

This structure refers to these other structures:

• NZ Patient (http://hl7.org.nz/fhir/StructureDefinition/NzPatient)
• NZ Medication Dispense (https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/NzPharmacyMedicationDispense)

Extensions

This structure refers to these extensions:

• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/transaction-category
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/extended-supply-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/psc-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Claim.meta.tag
• The element 1 is sliced based on the value of Claim.item.serviced[x]

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
Claim.meta	Σ This element is included in summaries.	1..1	Meta	Metadata about the resource
Claim.meta.source	Σ This element is included in summaries. C	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
Claim.meta.profile	Σ This element is included in summaries.	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Claim.meta.Slices for tag	Σ This element is included in summaries.	1..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.meta.Slices for tag.tag:correlationId	Σ This element is included in summaries.	1..1	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
Claim.meta.Slices for tag.tag:correlationId.system	Σ This element is included in summaries.	1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
Claim.meta.Slices for tag.tag:correlationId.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Claim.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for extension.extension:patientCohort		0..1	CodeableConcept	Patient Cohort URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort Binding: Patient Cohort ValueSet (required)
Claim.Slices for extension.extension:claimantNumber		1..1	string	Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number
Claim.Slices for extension.extension:originatingClaimantNumber		0..1	string	Originating Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number
Claim.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.identifier		1..*	Identifier	Business Identifier for claim
Claim.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Claim.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
Claim.identifier.value	Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
Claim.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Claim.type	Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: NZ Claim Types (extensible)
Claim.subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
Claim.use	Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Claim.patient	Σ This element is included in summaries.	1..1	Reference(NZ Patient | Patient)	The recipient of the products and services
Claim.patient.type	Σ This element is included in summaries.	1..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). Required Pattern: Patient
Claim.patient.identifier	Σ This element is included in summaries.	1..1	Identifier	Logical reference, when literal reference is not known
Claim.patient.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Claim.patient.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/nhi-id
Claim.patient.identifier.value	Σ This element is included in summaries. C	1..1	string	Must be an absolute URL reference to the patient on the NHI system. See constraints for details. Constraints: nhi-value-format Example General: 123456
Claim.billablePeriod	Σ This element is included in summaries.	1..1	Period	Relevant time frame for the claim
Claim.billablePeriod.start	Σ This element is included in summaries. C	1..1	dateTime	Starting time with inclusive boundary Constraints: date-only
Claim.billablePeriod.end	Σ This element is included in summaries. C	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: date-only
Claim.created	Σ This element is included in summaries. C	1..1	dateTime	Resource creation date Constraints: full-datetime-with-timezone
Claim.provider	Σ This element is included in summaries.	1..1	Reference(Organization)	Party responsible for the claim
Claim.provider.identifier	Σ This element is included in summaries. C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
Claim.provider.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Claim.provider.identifier.system	Σ This element is included in summaries. C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
Claim.provider.identifier.value	Σ This element is included in summaries.	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
Claim.priority	Σ This element is included in summaries.	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
Claim.insurance	Σ This element is included in summaries.	1..1	BackboneElement	Patient insurance information
Claim.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence	Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier
Claim.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication
Claim.insurance.coverage	Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Claim.item		1..*	BackboneElement	Product or service provided
Claim.item.Slices for extension		3..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for extension.extension:patientFlag		0..1	boolean	Patient Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag
Claim.item.Slices for extension.extension:request		1..1	(Complex)	Item Request URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request
Claim.item.Slices for extension.extension:request.extension		0..0		Extension Slice: Unordered, Open by value:url
Claim.item.Slices for extension.extension:request.url		1..1	uri	"https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request"
Claim.item.Slices for extension.extension:request.value[x]		1..1	Reference(NZ Medication Dispense)	Value of extension
Claim.item.Slices for extension.extension:prescriberFlag		0..1	boolean	Prescriber Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag
Claim.item.Slices for extension.extension:prescriptionFlag		0..1	boolean	Prescription Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag
Claim.item.Slices for extension.extension:doseFlag		0..1	boolean	Dose Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag
Claim.item.Slices for extension.extension:groupId		0..1	string	Group ID URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id
Claim.item.Slices for extension.extension:transactionCategory		1..1	CodeableConcept	Transaction Category URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/transaction-category Binding: NZ Pharmacy Transaction Category (required)
Claim.item.Slices for extension.extension:extendedSupplyFlag		0..1	boolean	Extended Supply Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/extended-supply-flag
Claim.item.Slices for extension.extension:classification		0..1	(Complex)	Classification Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification
Claim.item.Slices for extension.extension:classification.extension		0..0		Extension Slice: Unordered, Open by value:url
Claim.item.Slices for extension.extension:classification.url		1..1	uri	"https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification"
Claim.item.Slices for extension.extension:classification.value[x]		0..1	CodeableConcept	Value of extension Binding: NZ Pharmacy Claim Item Classification (required)
Claim.item.Slices for extension.extension:pscFlag		1..1	boolean	PSC Flag Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/psc-flag
Claim.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.sequence		1..1	positiveInt	Item instance identifier
Claim.item.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.Slices for serviced[x]		1..1	Period	Date or dates of service or product delivery Slice: Unordered, Closed by type:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod		1..1	Period	Date or dates of service or product delivery
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.start	Σ This element is included in summaries. C	1..1	dateTime	Starting time with inclusive boundary Constraints: full-datetime-with-timezone
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.end	Σ This element is included in summaries. C	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: full-datetime-with-timezone
Claim.item.detail		1..*	BackboneElement	Product or service provided
Claim.item.detail.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.detail.Slices for extension.extension:balanceOwing		0..1	string	Balance Owing URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing
Claim.item.detail.Slices for extension.extension:wastageQuantity		0..1	Quantity	Wastage Quantity URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity
Claim.item.detail.Slices for extension.extension:cbsSubsidy		0..1	Money	CBS Subsidy URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy
Claim.item.detail.Slices for extension.extension:cbsPackSize		0..1	Quantity	CBS Pack Size URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize
Claim.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.quantity	C	1..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.detail.net		1..1	Money	Total item cost
Claim.total		1..1	Money	Total claim cost
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.meta.tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
Claim.meta.tag:correlationId	Base	example	Common Tags	📍4.0.1	FHIR Std.
Claim.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	NZ Claim Types	📦0.4.7	This IG
Claim.subType	Base	extensible	NZ Claim Subtypes	📦0.4.7	This IG
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.patient.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.patient.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.provider.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.priority	Base	required	Process Priority Codes	📦4.0.1	FHIR Std.
Claim.payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.item.extension:classification.​value[x]	Base	required	NZ Pharmacy Claim Item Classification	📦0.4.7	This IG
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
allowedLocalIdentifierSystems	error	Claim.provider.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN	$this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
date-only	error	Claim.billablePeriod.start, Claim.billablePeriod.end	DateTime must be date-only in yyyy-mm-dd format. Time and timezone values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}$')
full-datetime-with-timezone	error	Claim.created, Claim.item.serviced[x]:servicedPeriod.start, Claim.item.serviced[x]:servicedPeriod.end	DateTime must be ISO 8601 format with time and timezone (e.g., 2026-01-01T00:00:00+13:00 or 2026-01-01T00:00:00Z). Date-only values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}T[0-9]{2}:[0-9]{2}:[0-9]{2}(\\.[0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
hpi-location-url-format	error	Claim.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A	matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	Claim.provider.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic).	system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	Claim.provider.identifier	HPI Facility ID must conform to format (FXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	Claim.provider.identifier	HPI Organisation ID must conform to format (GXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
nhi-value-format	error	Claim.patient.identifier.value	Reference must be an NHI Patient URL with format ZZZ1111 or ZZZ11AA	matches('^[A-Z]{3}([0-9]{4}|[0-9]{2}[A-Z]{2})$')
nzbnPattern	error	Claim.provider.identifier	NZBN must conform to format (13 digits).	system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

Differential View

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
Claim.meta		1..1	Meta	Metadata about the resource
Claim.meta.source	C	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
Claim.meta.profile		1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Claim.meta.Slices for tag		1..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.meta.Slices for tag.tag:correlationId		1..1	Coding	Tags applied to this resource
Claim.meta.Slices for tag.tag:correlationId.system		1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
Claim.meta.Slices for tag.tag:correlationId.code		1..1	code	Symbol in syntax defined by the system
Claim.contained		0..0		Contained, inline Resources
Claim.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for extension.extension:patientCohort		0..1	CodeableConcept	Patient Cohort URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort Binding: Patient Cohort ValueSet (required)
Claim.Slices for extension.extension:claimantNumber		1..1	string	Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number
Claim.Slices for extension.extension:originatingClaimantNumber		0..1	string	Originating Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number
Claim.identifier		1..*	Identifier	Business Identifier for claim
Claim.identifier.system		1..1	uri	The namespace for the identifier value
Claim.identifier.value		1..1	string	The value that is unique
Claim.type		1..1	CodeableConcept	Category or discipline Binding: NZ Claim Types (extensible)
Claim.subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
Claim.patient		1..1	Reference(NZ Patient | Patient)	The recipient of the products and services
Claim.patient.type		1..1	uri	Type the reference refers to (e.g. "Patient") Required Pattern: Patient
Claim.patient.identifier		1..1	Identifier	Logical reference, when literal reference is not known
Claim.patient.identifier.system		1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/nhi-id
Claim.patient.identifier.value	C	1..1	string	Must be an absolute URL reference to the patient on the NHI system. See constraints for details. Constraints: nhi-value-format
Claim.patient.display		0..0		Text alternative for the resource
Claim.billablePeriod		1..1	Period	Relevant time frame for the claim
Claim.billablePeriod.start	C	1..1	dateTime	Starting time with inclusive boundary Constraints: date-only
Claim.billablePeriod.end	C	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: date-only
Claim.created	C	1..1	dateTime	Resource creation date Constraints: full-datetime-with-timezone
Claim.insurer		0..0		Target
Claim.provider		1..1	Reference(Organization)	Party responsible for the claim
Claim.provider.identifier	C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
Claim.provider.identifier.use		0..1	code	The local identifier use SHOULD be set to official.
Claim.provider.identifier.system	C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
Claim.provider.identifier.value		1..1	string	The actual local identifier value, e.g. GZZ999-Z Example Example HPI Org ID: GZZ999-Z
Claim.priority		1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
Claim.fundsReserve		0..0		For whom to reserve funds
Claim.prescription		0..0		Prescription authorizing services and products
Claim.originalPrescription		0..0		Original prescription if superseded by fulfiller
Claim.payee		0..0		Recipient of benefits payable
Claim.careTeam		0..0		Members of the care team
Claim.diagnosis		0..0		Pertinent diagnosis information
Claim.procedure		0..0		Clinical procedures performed
Claim.insurance		1..1	BackboneElement	Patient insurance information
Claim.accident		0..0		Details of the event
Claim.item		1..*	BackboneElement	Product or service provided
Claim.item.Slices for extension		3..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for extension.extension:patientFlag		0..1	boolean	Patient Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag
Claim.item.Slices for extension.extension:request		1..1	(Complex)	Item Request URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request
Claim.item.Slices for extension.extension:request.value[x]		1..1	Reference(NZ Medication Dispense)	Value of extension
Claim.item.Slices for extension.extension:prescriberFlag		0..1	boolean	Prescriber Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag
Claim.item.Slices for extension.extension:prescriptionFlag		0..1	boolean	Prescription Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag
Claim.item.Slices for extension.extension:doseFlag		0..1	boolean	Dose Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag
Claim.item.Slices for extension.extension:groupId		0..1	string	Group ID URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id
Claim.item.Slices for extension.extension:transactionCategory		1..1	CodeableConcept	Transaction Category URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/transaction-category Binding: NZ Pharmacy Transaction Category (required)
Claim.item.Slices for extension.extension:extendedSupplyFlag		0..1	boolean	Extended Supply Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/extended-supply-flag
Claim.item.Slices for extension.extension:classification		0..1	(Complex)	Classification Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification
Claim.item.Slices for extension.extension:classification.value[x]		0..1	CodeableConcept	Value of extension Binding: NZ Pharmacy Claim Item Classification (required)
Claim.item.Slices for extension.extension:pscFlag		1..1	boolean	PSC Flag Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/psc-flag
Claim.item.revenue		0..0		Revenue or cost center code
Claim.item.category		0..0		Benefit classification
Claim.item.modifier		0..0		Product or service billing modifiers
Claim.item.programCode		0..0		Program the product or service is provided under
Claim.item.Slices for serviced[x]		1..1	Period	Date or dates of service or product delivery Slice: Unordered, Open by type:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod		1..1	Period	Date or dates of service or product delivery
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.start	C	1..1	dateTime	Starting time with inclusive boundary Constraints: full-datetime-with-timezone
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.end	C	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: full-datetime-with-timezone
Claim.item.udi		0..0		Unique device identifier
Claim.item.bodySite		0..0		Anatomical location
Claim.item.subSite		0..0		Anatomical sub-location
Claim.item.detail		1..*	BackboneElement	Product or service provided
Claim.item.detail.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.detail.Slices for extension.extension:balanceOwing		0..1	string	Balance Owing URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing
Claim.item.detail.Slices for extension.extension:wastageQuantity		0..1	Quantity	Wastage Quantity URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity
Claim.item.detail.Slices for extension.extension:cbsSubsidy		0..1	Money	CBS Subsidy URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy
Claim.item.detail.Slices for extension.extension:cbsPackSize		0..1	Quantity	CBS Pack Size URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize
Claim.item.detail.revenue		0..0		Revenue or cost center code
Claim.item.detail.category		0..0		Benefit classification
Claim.item.detail.modifier		0..0		Service/Product billing modifiers
Claim.item.detail.programCode		0..0		Program the product or service is provided under
Claim.item.detail.quantity		1..1	SimpleQuantity(4.0.1)	Count of products or services
Claim.item.detail.net		1..1	Money	Total item cost
Claim.item.detail.udi		0..0		Unique device identifier
Claim.total		1..1	Money	Total claim cost
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Claim.type	Base	extensible	NZ Claim Types	📦0.4.7	This IG
Claim.subType	Base	extensible	NZ Claim Subtypes	📦0.4.7	This IG
Claim.priority	Base	required	Process Priority Codes	📦4.0.1	FHIR Std.
Claim.item.extension:classification.​value[x]	Base	required	NZ Pharmacy Claim Item Classification	📦0.4.7	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
allowedLocalIdentifierSystems	error	Claim.provider.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN	$this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
date-only	error	Claim.billablePeriod.start, Claim.billablePeriod.end	DateTime must be date-only in yyyy-mm-dd format. Time and timezone values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}$')
full-datetime-with-timezone	error	Claim.created, Claim.item.serviced[x]:servicedPeriod.start, Claim.item.serviced[x]:servicedPeriod.end	DateTime must be ISO 8601 format with time and timezone (e.g., 2026-01-01T00:00:00+13:00 or 2026-01-01T00:00:00Z). Date-only values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}T[0-9]{2}:[0-9]{2}:[0-9]{2}(\\.[0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
hpi-location-url-format	error	Claim.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A	matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	Claim.provider.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic).	system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	Claim.provider.identifier	HPI Facility ID must conform to format (FXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	Claim.provider.identifier	HPI Organisation ID must conform to format (GXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
nhi-value-format	error	Claim.patient.identifier.value	Reference must be an NHI Patient URL with format ZZZ1111 or ZZZ11AA	matches('^[A-Z]{3}([0-9]{4}|[0-9]{2}[A-Z]{2})$')
nzbnPattern	error	Claim.provider.identifier	NZBN must conform to format (13 digits).	system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
Claim.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
Claim.meta	Σ This element is included in summaries.	1..1	Meta	Metadata about the resource
Claim.meta.id		0..1	string	Unique id for inter-element referencing
Claim.meta.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.meta.versionId	Σ This element is included in summaries.	0..1	id	Version specific identifier
Claim.meta.lastUpdated	Σ This element is included in summaries.	0..1	instant	When the resource version last changed
Claim.meta.source	Σ This element is included in summaries. C	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
Claim.meta.profile	Σ This element is included in summaries.	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Claim.meta.security	Σ This element is included in summaries.	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Claim.meta.Slices for tag	Σ This element is included in summaries.	1..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.meta.Slices for tag.tag:correlationId	Σ This element is included in summaries.	1..1	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
Claim.meta.Slices for tag.tag:correlationId.id		0..1	string	Unique id for inter-element referencing
Claim.meta.Slices for tag.tag:correlationId.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.meta.Slices for tag.tag:correlationId.system	Σ This element is included in summaries.	1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
Claim.meta.Slices for tag.tag:correlationId.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.meta.Slices for tag.tag:correlationId.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.meta.Slices for tag.tag:correlationId.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.meta.Slices for tag.tag:correlationId.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Claim.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Claim.text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Claim.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for extension.extension:patientCohort		0..1	CodeableConcept	Patient Cohort URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort Binding: Patient Cohort ValueSet (required)
Claim.Slices for extension.extension:claimantNumber		1..1	string	Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number
Claim.Slices for extension.extension:originatingClaimantNumber		0..1	string	Originating Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number
Claim.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.identifier		1..*	Identifier	Business Identifier for claim
Claim.identifier.id		0..1	string	Unique id for inter-element referencing
Claim.identifier.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Claim.identifier.type	Σ This element is included in summaries.	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Claim.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
Claim.identifier.value	Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
Claim.identifier.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
Claim.identifier.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
Claim.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Claim.type	Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: NZ Claim Types (extensible)
Claim.subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
Claim.use	Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Claim.patient	Σ This element is included in summaries.	1..1	Reference(NZ Patient | Patient)	The recipient of the products and services
Claim.patient.id		0..1	string	Unique id for inter-element referencing
Claim.patient.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.patient.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
Claim.patient.type	Σ This element is included in summaries.	1..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). Required Pattern: Patient
Claim.patient.identifier	Σ This element is included in summaries.	1..1	Identifier	Logical reference, when literal reference is not known
Claim.patient.identifier.id		0..1	string	Unique id for inter-element referencing
Claim.patient.identifier.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.patient.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Claim.patient.identifier.type	Σ This element is included in summaries.	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Claim.patient.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/nhi-id
Claim.patient.identifier.value	Σ This element is included in summaries. C	1..1	string	Must be an absolute URL reference to the patient on the NHI system. See constraints for details. Constraints: nhi-value-format Example General: 123456
Claim.patient.identifier.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
Claim.patient.identifier.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
Claim.billablePeriod	Σ This element is included in summaries.	1..1	Period	Relevant time frame for the claim
Claim.billablePeriod.id		0..1	string	Unique id for inter-element referencing
Claim.billablePeriod.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.billablePeriod.start	Σ This element is included in summaries. C	1..1	dateTime	Starting time with inclusive boundary Constraints: date-only
Claim.billablePeriod.end	Σ This element is included in summaries. C	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: date-only
Claim.created	Σ This element is included in summaries. C	1..1	dateTime	Resource creation date Constraints: full-datetime-with-timezone
Claim.enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
Claim.provider	Σ This element is included in summaries.	1..1	Reference(Organization)	Party responsible for the claim
Claim.provider.id		0..1	string	Unique id for inter-element referencing
Claim.provider.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.provider.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
Claim.provider.type	Σ This element is included in summaries.	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
Claim.provider.identifier	Σ This element is included in summaries. C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
Claim.provider.identifier.id		0..1	string	Unique id for inter-element referencing
Claim.provider.identifier.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.provider.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Claim.provider.identifier.type	Σ This element is included in summaries.	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Claim.provider.identifier.system	Σ This element is included in summaries. C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
Claim.provider.identifier.value	Σ This element is included in summaries.	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
Claim.provider.identifier.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
Claim.provider.identifier.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
Claim.provider.display	Σ This element is included in summaries.	0..1	string	Text alternative for the resource
Claim.priority	Σ This element is included in summaries.	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
Claim.related		0..*	BackboneElement	Prior or corollary claims
Claim.related.id		0..1	string	Unique id for inter-element referencing
Claim.related.extension		0..*	Extension	Additional content defined by implementations
Claim.related.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.related.claim		0..1	Reference(Claim)	Reference to the related claim
Claim.related.relationship		0..1	CodeableConcept	How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
Claim.related.reference		0..1	Identifier	File or case reference
Claim.referral		0..1	Reference(ServiceRequest)	Treatment referral
Claim.facility		0..1	Reference(Location)	Servicing facility
Claim.supportingInfo		0..*	BackboneElement	Supporting information
Claim.supportingInfo.id		0..1	string	Unique id for inter-element referencing
Claim.supportingInfo.extension		0..*	Extension	Additional content defined by implementations
Claim.supportingInfo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.supportingInfo.sequence		1..1	positiveInt	Information instance identifier
Claim.supportingInfo.category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.supportingInfo.code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.supportingInfo.timing[x]		0..1		When it occurred
Claim.supportingInfo.timing[x].timingDate			date
Claim.supportingInfo.timing[x].timingPeriod			Period
Claim.supportingInfo.value[x]		0..1		Data to be provided
Claim.supportingInfo.value[x].valueBoolean			boolean
Claim.supportingInfo.value[x].valueString			string
Claim.supportingInfo.value[x].valueQuantity			Quantity
Claim.supportingInfo.value[x].valueAttachment			Attachment
Claim.supportingInfo.value[x].valueReference			Reference(Resource)
Claim.supportingInfo.reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.insurance	Σ This element is included in summaries.	1..1	BackboneElement	Patient insurance information
Claim.insurance.id		0..1	string	Unique id for inter-element referencing
Claim.insurance.extension		0..*	Extension	Additional content defined by implementations
Claim.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence	Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier
Claim.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication
Claim.insurance.identifier		0..1	Identifier	Pre-assigned Claim number
Claim.insurance.coverage	Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Claim.insurance.businessArrangement		0..1	string	Additional provider contract number
Claim.insurance.preAuthRef		0..*	string	Prior authorization reference number
Claim.insurance.claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
Claim.item		1..*	BackboneElement	Product or service provided
Claim.item.id		0..1	string	Unique id for inter-element referencing
Claim.item.Slices for extension		3..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for extension.extension:patientFlag		0..1	boolean	Patient Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag
Claim.item.Slices for extension.extension:request		1..1	(Complex)	Item Request URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request
Claim.item.Slices for extension.extension:request.id		0..1	string	Unique id for inter-element referencing
Claim.item.Slices for extension.extension:request.extension		0..0		Extension Slice: Unordered, Open by value:url
Claim.item.Slices for extension.extension:request.url		1..1	uri	"https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request"
Claim.item.Slices for extension.extension:request.value[x]		1..1	Reference(NZ Medication Dispense)	Value of extension
Claim.item.Slices for extension.extension:prescriberFlag		0..1	boolean	Prescriber Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag
Claim.item.Slices for extension.extension:prescriptionFlag		0..1	boolean	Prescription Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag
Claim.item.Slices for extension.extension:doseFlag		0..1	boolean	Dose Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag
Claim.item.Slices for extension.extension:groupId		0..1	string	Group ID URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id
Claim.item.Slices for extension.extension:transactionCategory		1..1	CodeableConcept	Transaction Category URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/transaction-category Binding: NZ Pharmacy Transaction Category (required)
Claim.item.Slices for extension.extension:extendedSupplyFlag		0..1	boolean	Extended Supply Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/extended-supply-flag
Claim.item.Slices for extension.extension:classification		0..1	(Complex)	Classification Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification
Claim.item.Slices for extension.extension:classification.id		0..1	string	Unique id for inter-element referencing
Claim.item.Slices for extension.extension:classification.extension		0..0		Extension Slice: Unordered, Open by value:url
Claim.item.Slices for extension.extension:classification.url		1..1	uri	"https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification"
Claim.item.Slices for extension.extension:classification.value[x]		0..1	CodeableConcept	Value of extension Binding: NZ Pharmacy Claim Item Classification (required)
Claim.item.Slices for extension.extension:pscFlag		1..1	boolean	PSC Flag Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/psc-flag
Claim.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.sequence		1..1	positiveInt	Item instance identifier
Claim.item.careTeamSequence		0..*	positiveInt	Applicable careTeam members
Claim.item.diagnosisSequence		0..*	positiveInt	Applicable diagnoses
Claim.item.procedureSequence		0..*	positiveInt	Applicable procedures
Claim.item.informationSequence		0..*	positiveInt	Applicable exception and supporting information
Claim.item.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.Slices for serviced[x]		1..1	Period	Date or dates of service or product delivery Slice: Unordered, Closed by type:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod		1..1	Period	Date or dates of service or product delivery
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.id		0..1	string	Unique id for inter-element referencing
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.start	Σ This element is included in summaries. C	1..1	dateTime	Starting time with inclusive boundary Constraints: full-datetime-with-timezone
Claim.item.Slices for serviced[x].serviced[x]:servicedPeriod.end	Σ This element is included in summaries. C	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: full-datetime-with-timezone
Claim.item.location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
Claim.item.location[x].locationCodeableConcept			CodeableConcept
Claim.item.location[x].locationAddress			Address
Claim.item.location[x].locationReference			Reference(Location)
Claim.item.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.factor		0..1	decimal	Price scaling factor
Claim.item.net		0..1	Money	Total item cost
Claim.item.encounter		0..*	Reference(Encounter)	Encounters related to this billed item
Claim.item.detail		1..*	BackboneElement	Product or service provided
Claim.item.detail.id		0..1	string	Unique id for inter-element referencing
Claim.item.detail.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.item.detail.Slices for extension.extension:balanceOwing		0..1	string	Balance Owing URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing
Claim.item.detail.Slices for extension.extension:wastageQuantity		0..1	Quantity	Wastage Quantity URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity
Claim.item.detail.Slices for extension.extension:cbsSubsidy		0..1	Money	CBS Subsidy URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy
Claim.item.detail.Slices for extension.extension:cbsPackSize		0..1	Quantity	CBS Pack Size URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize
Claim.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.quantity	C	1..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.detail.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.detail.factor		0..1	decimal	Price scaling factor
Claim.item.detail.net		1..1	Money	Total item cost
Claim.item.detail.subDetail		0..*	BackboneElement	Product or service provided
Claim.item.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
Claim.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
Claim.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.subDetail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.subDetail.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.detail.subDetail.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.subDetail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.subDetail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.detail.subDetail.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.detail.subDetail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.detail.subDetail.factor		0..1	decimal	Price scaling factor
Claim.item.detail.subDetail.net		0..1	Money	Total item cost
Claim.item.detail.subDetail.udi		0..*	Reference(Device)	Unique device identifier
Claim.total		1..1	Money	Total claim cost
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.meta.security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
Claim.meta.tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
Claim.meta.tag:correlationId	Base	example	Common Tags	📍4.0.1	FHIR Std.
Claim.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Claim.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.identifier.type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	NZ Claim Types	📦0.4.7	This IG
Claim.subType	Base	extensible	NZ Claim Subtypes	📦0.4.7	This IG
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.patient.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.patient.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.patient.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Claim.provider.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.provider.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.provider.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Claim.priority	Base	required	Process Priority Codes	📦4.0.1	FHIR Std.
Claim.related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.0.1	FHIR Std.
Claim.payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
Claim.careTeam.role	Base	example	Claim Care Team Role Codes	📍4.0.1	FHIR Std.
Claim.careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.0.1	FHIR Std.
Claim.procedure.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.accident.type	Base	extensible	ActIncidentCode	📦3.0.0	THO v6.5
Claim.item.extension:classification.​value[x]	Base	required	NZ Pharmacy Claim Item Classification	📦0.4.7	This IG
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
allowedLocalIdentifierSystems	error	Claim.provider.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN	$this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
date-only	error	Claim.billablePeriod.start, Claim.billablePeriod.end	DateTime must be date-only in yyyy-mm-dd format. Time and timezone values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}$')
full-datetime-with-timezone	error	Claim.created, Claim.item.serviced[x]:servicedPeriod.start, Claim.item.serviced[x]:servicedPeriod.end	DateTime must be ISO 8601 format with time and timezone (e.g., 2026-01-01T00:00:00+13:00 or 2026-01-01T00:00:00Z). Date-only values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}T[0-9]{2}:[0-9]{2}:[0-9]{2}(\\.[0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
hpi-location-url-format	error	Claim.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A	matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	Claim.provider.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic).	system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	Claim.provider.identifier	HPI Facility ID must conform to format (FXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	Claim.provider.identifier	HPI Organisation ID must conform to format (GXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
nhi-value-format	error	Claim.patient.identifier.value	Reference must be an NHI Patient URL with format ZZZ1111 or ZZZ11AA	matches('^[A-Z]{3}([0-9]{4}|[0-9]{2}[A-Z]{2})$')
nzbnPattern	error	Claim.provider.identifier	NZBN must conform to format (13 digits).	system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

This structure is derived from Claim

Summary

Mandatory: 35 elements
Fixed: 1 element
Prohibited: 23 elements

Structures

This structure refers to these other structures:

• NZ Patient (http://hl7.org.nz/fhir/StructureDefinition/NzPatient)
• NZ Medication Dispense (https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/NzPharmacyMedicationDispense)

Extensions

This structure refers to these extensions:

• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/transaction-category
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/extended-supply-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/psc-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Claim.meta.tag
• The element 1 is sliced based on the value of Claim.item.serviced[x]