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

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

Resource Profile: NZ SharedCare Claim

Official URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/SharedCareClaim Version: 1.0.5
Active as of 2026-10-13 Computable Name: SharedCareClaim

A FHIR resource profile for NZ generic payment claims.

A FHIR resource profile for NZ generic payment claims.

Usages:

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.

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Claim C 0..* Claim Claim, Pre-determination or Pre-authorization
Constraints: unique-claim-item-sequence
Claim.meta This element is included in summaries. 1..1 Meta Metadata about the resource
Claim.meta.source 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 This element is included in summaries. 1..1 canonical(StructureDefinition) Profiles this resource claims to conform to
Claim.meta.Slices for tag 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 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 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 This element is included in summaries. 1..1 code Symbol in syntax defined by the system
Claim.implicitRules This element is a modifier element. 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:traceNumber 0..* Identifier Shared Care Claim Trace Number
URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
Claim.Slices for extension.extension:agreementNumber 1..1 string Shared Care Agreement Number
URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-agreement-number
Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Claim.identifier 0..* Identifier Business identifier(s) for the claim
Claim.identifier.use This element is a modifier element. 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 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 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. 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 This element is included in summaries. 1..1 CodeableConcept Claim type
Binding: NZ Claim Types (extensible)
Claim.subType 0..1 CodeableConcept Claim subtype
Binding: NZ Claim Subtypes (extensible)
Claim.use 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 This element is included in summaries. 1..1 Reference(NZ Patient | Patient) The recipient of the products and services
Claim.patient.type 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 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. 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 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 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 This element is included in summaries. 1..1 Period Billing period with datetime including timezone (start is inclusive, end is exclusive)
Claim.billablePeriod.start This element is included in summaries. C 0..1 dateTime Starting time with inclusive boundary
Constraints: full-datetime-with-timezone
Claim.billablePeriod.end This element is included in summaries. C 0..1 dateTime End time with inclusive boundary, if not ongoing
Constraints: full-datetime-with-timezone
Claim.created This element is included in summaries. C 1..1 dateTime Resource creation date
Constraints: full-datetime-with-timezone
Claim.provider This element is included in summaries. 1..1 Reference(Organization) Legal entity who submitted the claim
Claim.provider.identifier 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. 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 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 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 This element is included in summaries. 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.supportingInfo 0..* BackboneElement Additional attributes that may accompany a Claim
Claim.supportingInfo.modifierExtension This element is a modifier element. 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.insurance This element is included in summaries. 1..1 BackboneElement Patient insurance information
Claim.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence This element is included in summaries. 1..1 positiveInt Insurance instance identifier
Claim.insurance.focal This element is included in summaries. 1..1 boolean Coverage to be used for adjudication
Claim.insurance.coverage This element is included in summaries. 1..1 Reference(Coverage) Insurance information
Claim.item 0..* BackboneElement Each individual product or service being claimed for as part of this claim
Claim.item.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.Slices for extension.extension:patientPaid 0..1 Money Shared Care Patient Copayment
URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-patient-copayment
Claim.item.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.item.sequence This element must be supported. 1..1 positiveInt Referred to by the ClaimResponse.item.itemSequence
Claim.item.productOrService 1..1 CodeableConcept Product or service being claimed (e.g., PU code)
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.serviced[x] 0..1 Period When the claimed event started and ended
Claim.item.serviced[x].start This element is included in summaries. C 0..1 dateTime Starting time with inclusive boundary
Constraints: full-datetime-with-timezone
Claim.item.serviced[x].end This element is included in summaries. C 0..1 dateTime End time with inclusive boundary, if not ongoing
Constraints: full-datetime-with-timezone
Claim.item.Slices for location[x] 0..1 Place of service or where product was supplied
Slice: Unordered, Closed by type:$this
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them Other type slices that contain no new information are not shown in this view
Claim.item.Slices for location[x].locationCodeableConcept CodeableConcept
Claim.item.Slices for location[x].locationAddress Address
Claim.item.Slices for location[x].locationReference Reference(Location)
Claim.item.Slices for location[x].location[x]:locationReference 0..1 Reference(Location) HPI Facility
Claim.item.Slices for location[x].location[x]:locationReference.identifier 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.item.Slices for location[x].location[x]:locationReference.identifier.use This element is a modifier element. 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.item.Slices for location[x].location[x]:locationReference.identifier.system 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.item.Slices for location[x].location[x]:locationReference.identifier.value 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

doco 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 example Process Priority Codes 📍4.0.1 FHIR Std.
Claim.payee.type Base example PayeeType 📍4.0.1 FHIR Std.
Claim.supportingInfo.​category Base example Claim Information Category Codes 📍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.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.location[x]:locationReference.​identifier.use Base required IdentifierUse 📍4.0.1 FHIR Std.
Claim.item.location[x]:locationCodeableConcept Base example Example Service Place Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
allowedLocalIdentifierSystems error Claim.provider.identifier.system, Claim.item.location[x]:locationReference.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 $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
full-datetime-with-timezone error Claim.billablePeriod.start, Claim.billablePeriod.end, Claim.created, Claim.item.serviced[x].start, Claim.item.serviced[x].end DateTime must be ISO 8601 format with time and timezone (e.g., 2026-01-01T00:00:00+13:00 or 2026-01-01T00:00:00Z). Date-only values are not accepted. toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}T[0-9]{2}:[0-9]{2}:[0-9]{2}(\\.[0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
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]$')
hpiCpnPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.identifier HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic). system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.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]$')
hpiOrganizationIdPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.identifier HPI Organisation ID must conform to format (GXXnnn-C). system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
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})$')
nzbnPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.identifier NZBN must conform to format (13 digits). system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')
unique-claim-item-sequence error Claim Each item.sequence must be unique within the Claim item.sequence.isDistinct()

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Claim C 0..* Claim Claim, Pre-determination or Pre-authorization
Constraints: unique-claim-item-sequence
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:traceNumber 0..* Identifier Shared Care Claim Trace Number
URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
Claim.Slices for extension.extension:agreementNumber 1..1 string Shared Care Agreement Number
URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-agreement-number
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 Claim type
Binding: NZ Claim Types (extensible)
Claim.subType 0..1 CodeableConcept Claim subtype
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 Billing period with datetime including timezone (start is inclusive, end is exclusive)
Claim.billablePeriod.start C 0..1 dateTime Starting time with inclusive boundary
Constraints: full-datetime-with-timezone
Claim.billablePeriod.end C 0..1 dateTime End time with inclusive boundary, if not ongoing
Constraints: full-datetime-with-timezone
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) Legal entity who submitted 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.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.supportingInfo 0..* BackboneElement Additional attributes that may accompany a Claim
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 0..* BackboneElement Each individual product or service being claimed for as part of this claim
Claim.item.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.Slices for extension.extension:patientPaid 0..1 Money Shared Care Patient Copayment
URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-patient-copayment
Claim.item.sequence This element must be supported. 1..1 positiveInt Referred to by the ClaimResponse.item.itemSequence
Claim.item.productOrService 1..1 CodeableConcept Product or service being claimed (e.g., PU code)
Claim.item.serviced[x] 0..1 Period When the claimed event started and ended
Claim.item.serviced[x].start C 0..1 dateTime Starting time with inclusive boundary
Constraints: full-datetime-with-timezone
Claim.item.serviced[x].end C 0..1 dateTime End time with inclusive boundary, if not ongoing
Constraints: full-datetime-with-timezone
Claim.item.Slices for location[x] 0..1 CodeableConcept, Address, Reference(Location) Place of service or where product was supplied
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 Other type slices that contain no new information are not shown in this view
Claim.item.Slices for location[x].location[x]:locationReference 0..1 Reference(Location) HPI Facility
Claim.item.Slices for location[x].location[x]:locationReference.identifier C 1..1 Identifier A local identifier MUST be added to this section.
Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
Claim.item.Slices for location[x].location[x]:locationReference.identifier.use 0..1 code The local identifier use SHOULD be set to official.
Claim.item.Slices for location[x].location[x]:locationReference.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.item.Slices for location[x].location[x]:locationReference.identifier.value 1..1 string The actual local identifier value, e.g. GZZ999-Z
Example Example HPI Org ID: GZZ999-Z
Claim.item.unitPrice 0..0 Fee, charge or cost per item
Claim.item.net 0..0 Total item cost
Claim.item.encounter
Claim.item.encounter.reference 1..1 string Literal reference, Relative, internal or absolute URL
Claim.item.encounter.identifier 0..0 Logical reference, when literal reference is not known
Claim.item.encounter.display 0..0 Text alternative for the resource
Claim.item.detail
Claim.item.detail.unitPrice 0..0 Fee, charge or cost per item
Claim.item.detail.net 0..0 Total item cost
Claim.item.detail.subDetail
Claim.item.detail.subDetail.unitPrice 0..0 Fee, charge or cost per item
Claim.item.detail.subDetail.net 0..0 Total item cost
Claim.total 0..0 Total claim cost

doco 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

Constraints

Id Grade Path(s) Description Expression
allowedLocalIdentifierSystems error Claim.provider.identifier.system, Claim.item.location[x]:locationReference.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 $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
full-datetime-with-timezone error Claim.billablePeriod.start, Claim.billablePeriod.end, Claim.created, Claim.item.serviced[x].start, Claim.item.serviced[x].end DateTime must be ISO 8601 format with time and timezone (e.g., 2026-01-01T00:00:00+13:00 or 2026-01-01T00:00:00Z). Date-only values are not accepted. toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}T[0-9]{2}:[0-9]{2}:[0-9]{2}(\\.[0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
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]$')
hpiCpnPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.identifier HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic). system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.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]$')
hpiOrganizationIdPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.identifier HPI Organisation ID must conform to format (GXXnnn-C). system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
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})$')
nzbnPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.identifier NZBN must conform to format (13 digits). system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')
unique-claim-item-sequence error Claim Each item.sequence must be unique within the Claim item.sequence.isDistinct()
NameFlagsCard.TypeDescription & Constraints    Filter: doco
Claim C 0..* Claim Claim, Pre-determination or Pre-authorization
Constraints: unique-claim-item-sequence
Claim.id This element is included in summaries. 0..1 id Logical id of this artifact
Claim.meta 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 This element is included in summaries. 0..1 id Version specific identifier
Claim.meta.lastUpdated This element is included in summaries. 0..1 instant When the resource version last changed
Claim.meta.source 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 This element is included in summaries. 1..1 canonical(StructureDefinition) Profiles this resource claims to conform to
Claim.meta.security 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 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 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 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 This element is included in summaries. 0..1 string Version of the system - if relevant
Claim.meta.Slices for tag.tag:correlationId.code This element is included in summaries. 1..1 code Symbol in syntax defined by the system
Claim.meta.Slices for tag.tag:correlationId.display This element is included in summaries. 0..1 string Representation defined by the system
Claim.meta.Slices for tag.tag:correlationId.userSelected 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. 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 BindingsPurpose
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:traceNumber 0..* Identifier Shared Care Claim Trace Number
URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
Claim.Slices for extension.extension:agreementNumber 1..1 string Shared Care Agreement Number
URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-agreement-number
Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Claim.identifier 0..* Identifier Business identifier(s) for the 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. 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 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 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 This element is included in summaries. 1..1 string The value that is unique
Example General: 123456
Claim.identifier.period This element is included in summaries. 0..1 Period Time period when id is/was valid for use
Claim.identifier.assigner 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. 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 This element is included in summaries. 1..1 CodeableConcept Claim type
Binding: NZ Claim Types (extensible)
Claim.subType 0..1 CodeableConcept Claim subtype
Binding: NZ Claim Subtypes (extensible)
Claim.use 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 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 This element is included in summaries. C 0..1 string Literal reference, Relative, internal or absolute URL
Claim.patient.type 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 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. 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 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 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 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 This element is included in summaries. 0..1 Period Time period when id is/was valid for use
Claim.patient.identifier.assigner This element is included in summaries. 0..1 Reference(Organization) Organization that issued id (may be just text)
Claim.billablePeriod This element is included in summaries. 1..1 Period Billing period with datetime including timezone (start is inclusive, end is exclusive)
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 This element is included in summaries. C 0..1 dateTime Starting time with inclusive boundary
Constraints: full-datetime-with-timezone
Claim.billablePeriod.end This element is included in summaries. C 0..1 dateTime End time with inclusive boundary, if not ongoing
Constraints: full-datetime-with-timezone
Claim.created 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 This element is included in summaries. 1..1 Reference(Organization) Legal entity who submitted 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 This element is included in summaries. C 0..1 string Literal reference, Relative, internal or absolute URL
Claim.provider.type 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 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. 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 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 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 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 This element is included in summaries. 0..1 Period Time period when id is/was valid for use
Claim.provider.identifier.assigner This element is included in summaries. 0..1 Reference(Organization) Organization that issued id (may be just text)
Claim.provider.display This element is included in summaries. 0..1 string Text alternative for the resource
Claim.priority This element is included in summaries. 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
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. 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 Additional attributes that may accompany a Claim
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. 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 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. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence This element is included in summaries. 1..1 positiveInt Insurance instance identifier
Claim.insurance.focal 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 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 0..* BackboneElement Each individual product or service being claimed for as part of this claim
Claim.item.id 0..1 string Unique id for inter-element referencing
Claim.item.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.Slices for extension.extension:patientPaid 0..1 Money Shared Care Patient Copayment
URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-patient-copayment
Claim.item.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.item.sequence This element must be supported. 1..1 positiveInt Referred to by the ClaimResponse.item.itemSequence
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.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.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.productOrService 1..1 CodeableConcept Product or service being claimed (e.g., PU code)
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.serviced[x] 0..1 Period When the claimed event started and ended
Claim.item.serviced[x].id 0..1 string Unique id for inter-element referencing
Claim.item.serviced[x].extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.item.serviced[x].start This element is included in summaries. C 0..1 dateTime Starting time with inclusive boundary
Constraints: full-datetime-with-timezone
Claim.item.serviced[x].end This element is included in summaries. C 0..1 dateTime End time with inclusive boundary, if not ongoing
Constraints: full-datetime-with-timezone
Claim.item.Slices for location[x] 0..1 Place of service or where product was supplied
Slice: Unordered, Closed by type:$this
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them Other type slices that contain no new information are not shown in this view
Claim.item.Slices for location[x].locationCodeableConcept CodeableConcept
Claim.item.Slices for location[x].locationAddress Address
Claim.item.Slices for location[x].locationReference Reference(Location)
Claim.item.Slices for location[x].location[x]:locationReference 0..1 Reference(Location) HPI Facility
Claim.item.Slices for location[x].location[x]:locationReference.id 0..1 string Unique id for inter-element referencing
Claim.item.Slices for location[x].location[x]:locationReference.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.item.Slices for location[x].location[x]:locationReference.reference This element is included in summaries. C 0..1 string Literal reference, Relative, internal or absolute URL
Claim.item.Slices for location[x].location[x]:locationReference.type 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.item.Slices for location[x].location[x]:locationReference.identifier 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.item.Slices for location[x].location[x]:locationReference.identifier.id 0..1 string Unique id for inter-element referencing
Claim.item.Slices for location[x].location[x]:locationReference.identifier.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.item.Slices for location[x].location[x]:locationReference.identifier.use This element is a modifier element. 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.item.Slices for location[x].location[x]:locationReference.identifier.type 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.item.Slices for location[x].location[x]:locationReference.identifier.system 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.item.Slices for location[x].location[x]:locationReference.identifier.value 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.item.Slices for location[x].location[x]:locationReference.identifier.period This element is included in summaries. 0..1 Period Time period when id is/was valid for use
Claim.item.Slices for location[x].location[x]:locationReference.identifier.assigner This element is included in summaries. 0..1 Reference(Organization) Organization that issued id (may be just text)
Claim.item.Slices for location[x].location[x]:locationReference.display This element is included in summaries. 0..1 string Text alternative for the resource
Claim.item.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.item.factor 0..1 decimal Price scaling factor
Claim.item.udi 0..* Reference(Device) Unique device identifier
Claim.item.bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
Claim.item.subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
Claim.item.encounter 0..* Reference(Encounter) Encounters related to this billed item
Claim.item.encounter.id 0..1 string Unique id for inter-element referencing
Claim.item.encounter.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.item.encounter.reference This element is included in summaries. C 1..1 string Literal reference, Relative, internal or absolute URL
Claim.item.encounter.type 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.item.detail 0..* BackboneElement Product or service provided
Claim.item.detail.id 0..1 string Unique id for inter-element referencing
Claim.item.detail.extension 0..* Extension Additional content defined by implementations
Claim.item.detail.modifierExtension This element is a modifier element. 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.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.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.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.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.detail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.item.detail.factor 0..1 decimal Price scaling factor
Claim.item.detail.udi 0..* Reference(Device) Unique device identifier
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. 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.factor 0..1 decimal Price scaling factor
Claim.item.detail.subDetail.udi 0..* Reference(Device) Unique device identifier

doco 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 example 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.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item.location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
Claim.item.location[x]:locationReference.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
Claim.item.location[x]:locationReference.​identifier.use Base required IdentifierUse 📍4.0.1 FHIR Std.
Claim.item.location[x]:locationReference.​identifier.type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Claim.item.location[x]:locationCodeableConcept Base example Example Service Place Codes 📍4.0.1 FHIR Std.
Claim.item.bodySite Base example Oral Site Codes 📍4.0.1 FHIR Std.
Claim.item.subSite Base example Surface Codes 📍4.0.1 FHIR Std.
Claim.item.encounter.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
Claim.item.detail.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item.detail.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item.detail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item.detail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item.detail.programCode Base example Example Program Reason 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, Claim.item.location[x]:locationReference.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 $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
full-datetime-with-timezone error Claim.billablePeriod.start, Claim.billablePeriod.end, Claim.created, Claim.item.serviced[x].start, Claim.item.serviced[x].end DateTime must be ISO 8601 format with time and timezone (e.g., 2026-01-01T00:00:00+13:00 or 2026-01-01T00:00:00Z). Date-only values are not accepted. toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}T[0-9]{2}:[0-9]{2}:[0-9]{2}(\\.[0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
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]$')
hpiCpnPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.identifier HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic). system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.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]$')
hpiOrganizationIdPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.identifier HPI Organisation ID must conform to format (GXXnnn-C). system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
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})$')
nzbnPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.identifier NZBN must conform to format (13 digits). system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')
unique-claim-item-sequence error Claim Each item.sequence must be unique within the Claim item.sequence.isDistinct()

This structure is derived from Claim

Summary

Mandatory: 17 elements(6 nested mandatory elements)
Must-Support: 1 element
Fixed: 1 element
Prohibited: 20 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

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.location[x]

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Claim C 0..* Claim Claim, Pre-determination or Pre-authorization
Constraints: unique-claim-item-sequence
Claim.meta This element is included in summaries. 1..1 Meta Metadata about the resource
Claim.meta.source 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 This element is included in summaries. 1..1 canonical(StructureDefinition) Profiles this resource claims to conform to
Claim.meta.Slices for tag 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 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 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 This element is included in summaries. 1..1 code Symbol in syntax defined by the system
Claim.implicitRules This element is a modifier element. 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:traceNumber 0..* Identifier Shared Care Claim Trace Number
URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
Claim.Slices for extension.extension:agreementNumber 1..1 string Shared Care Agreement Number
URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-agreement-number
Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Claim.identifier 0..* Identifier Business identifier(s) for the claim
Claim.identifier.use This element is a modifier element. 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 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 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. 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 This element is included in summaries. 1..1 CodeableConcept Claim type
Binding: NZ Claim Types (extensible)
Claim.subType 0..1 CodeableConcept Claim subtype
Binding: NZ Claim Subtypes (extensible)
Claim.use 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 This element is included in summaries. 1..1 Reference(NZ Patient | Patient) The recipient of the products and services
Claim.patient.type 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 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. 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 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 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 This element is included in summaries. 1..1 Period Billing period with datetime including timezone (start is inclusive, end is exclusive)
Claim.billablePeriod.start This element is included in summaries. C 0..1 dateTime Starting time with inclusive boundary
Constraints: full-datetime-with-timezone
Claim.billablePeriod.end This element is included in summaries. C 0..1 dateTime End time with inclusive boundary, if not ongoing
Constraints: full-datetime-with-timezone
Claim.created This element is included in summaries. C 1..1 dateTime Resource creation date
Constraints: full-datetime-with-timezone
Claim.provider This element is included in summaries. 1..1 Reference(Organization) Legal entity who submitted the claim
Claim.provider.identifier 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. 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 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 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 This element is included in summaries. 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.supportingInfo 0..* BackboneElement Additional attributes that may accompany a Claim
Claim.supportingInfo.modifierExtension This element is a modifier element. 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.insurance This element is included in summaries. 1..1 BackboneElement Patient insurance information
Claim.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence This element is included in summaries. 1..1 positiveInt Insurance instance identifier
Claim.insurance.focal This element is included in summaries. 1..1 boolean Coverage to be used for adjudication
Claim.insurance.coverage This element is included in summaries. 1..1 Reference(Coverage) Insurance information
Claim.item 0..* BackboneElement Each individual product or service being claimed for as part of this claim
Claim.item.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.Slices for extension.extension:patientPaid 0..1 Money Shared Care Patient Copayment
URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-patient-copayment
Claim.item.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.item.sequence This element must be supported. 1..1 positiveInt Referred to by the ClaimResponse.item.itemSequence
Claim.item.productOrService 1..1 CodeableConcept Product or service being claimed (e.g., PU code)
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.serviced[x] 0..1 Period When the claimed event started and ended
Claim.item.serviced[x].start This element is included in summaries. C 0..1 dateTime Starting time with inclusive boundary
Constraints: full-datetime-with-timezone
Claim.item.serviced[x].end This element is included in summaries. C 0..1 dateTime End time with inclusive boundary, if not ongoing
Constraints: full-datetime-with-timezone
Claim.item.Slices for location[x] 0..1 Place of service or where product was supplied
Slice: Unordered, Closed by type:$this
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them Other type slices that contain no new information are not shown in this view
Claim.item.Slices for location[x].locationCodeableConcept CodeableConcept
Claim.item.Slices for location[x].locationAddress Address
Claim.item.Slices for location[x].locationReference Reference(Location)
Claim.item.Slices for location[x].location[x]:locationReference 0..1 Reference(Location) HPI Facility
Claim.item.Slices for location[x].location[x]:locationReference.identifier 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.item.Slices for location[x].location[x]:locationReference.identifier.use This element is a modifier element. 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.item.Slices for location[x].location[x]:locationReference.identifier.system 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.item.Slices for location[x].location[x]:locationReference.identifier.value 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

doco 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 example Process Priority Codes 📍4.0.1 FHIR Std.
Claim.payee.type Base example PayeeType 📍4.0.1 FHIR Std.
Claim.supportingInfo.​category Base example Claim Information Category Codes 📍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.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.location[x]:locationReference.​identifier.use Base required IdentifierUse 📍4.0.1 FHIR Std.
Claim.item.location[x]:locationCodeableConcept Base example Example Service Place Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
allowedLocalIdentifierSystems error Claim.provider.identifier.system, Claim.item.location[x]:locationReference.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 $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
full-datetime-with-timezone error Claim.billablePeriod.start, Claim.billablePeriod.end, Claim.created, Claim.item.serviced[x].start, Claim.item.serviced[x].end DateTime must be ISO 8601 format with time and timezone (e.g., 2026-01-01T00:00:00+13:00 or 2026-01-01T00:00:00Z). Date-only values are not accepted. toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}T[0-9]{2}:[0-9]{2}:[0-9]{2}(\\.[0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
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]$')
hpiCpnPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.identifier HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic). system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.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]$')
hpiOrganizationIdPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.identifier HPI Organisation ID must conform to format (GXXnnn-C). system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
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})$')
nzbnPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.identifier NZBN must conform to format (13 digits). system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')
unique-claim-item-sequence error Claim Each item.sequence must be unique within the Claim item.sequence.isDistinct()

Differential View

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Claim C 0..* Claim Claim, Pre-determination or Pre-authorization
Constraints: unique-claim-item-sequence
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:traceNumber 0..* Identifier Shared Care Claim Trace Number
URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
Claim.Slices for extension.extension:agreementNumber 1..1 string Shared Care Agreement Number
URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-agreement-number
Claim.identifier 0..* Identifier Business identifier(s) for the 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 Claim type
Binding: NZ Claim Types (extensible)
Claim.subType 0..1 CodeableConcept Claim subtype
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 Billing period with datetime including timezone (start is inclusive, end is exclusive)
Claim.billablePeriod.start C 0..1 dateTime Starting time with inclusive boundary
Constraints: full-datetime-with-timezone
Claim.billablePeriod.end C 0..1 dateTime End time with inclusive boundary, if not ongoing
Constraints: full-datetime-with-timezone
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) Legal entity who submitted 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.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.supportingInfo 0..* BackboneElement Additional attributes that may accompany a Claim
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 0..* BackboneElement Each individual product or service being claimed for as part of this claim
Claim.item.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.Slices for extension.extension:patientPaid 0..1 Money Shared Care Patient Copayment
URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-patient-copayment
Claim.item.sequence This element must be supported. 1..1 positiveInt Referred to by the ClaimResponse.item.itemSequence
Claim.item.productOrService 1..1 CodeableConcept Product or service being claimed (e.g., PU code)
Claim.item.serviced[x] 0..1 Period When the claimed event started and ended
Claim.item.serviced[x].start C 0..1 dateTime Starting time with inclusive boundary
Constraints: full-datetime-with-timezone
Claim.item.serviced[x].end C 0..1 dateTime End time with inclusive boundary, if not ongoing
Constraints: full-datetime-with-timezone
Claim.item.Slices for location[x] 0..1 CodeableConcept, Address, Reference(Location) Place of service or where product was supplied
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 Other type slices that contain no new information are not shown in this view
Claim.item.Slices for location[x].location[x]:locationReference 0..1 Reference(Location) HPI Facility
Claim.item.Slices for location[x].location[x]:locationReference.identifier C 1..1 Identifier A local identifier MUST be added to this section.
Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
Claim.item.Slices for location[x].location[x]:locationReference.identifier.use 0..1 code The local identifier use SHOULD be set to official.
Claim.item.Slices for location[x].location[x]:locationReference.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.item.Slices for location[x].location[x]:locationReference.identifier.value 1..1 string The actual local identifier value, e.g. GZZ999-Z
Example Example HPI Org ID: GZZ999-Z
Claim.item.unitPrice 0..0 Fee, charge or cost per item
Claim.item.net 0..0 Total item cost
Claim.item.encounter
Claim.item.encounter.reference 1..1 string Literal reference, Relative, internal or absolute URL
Claim.item.encounter.identifier 0..0 Logical reference, when literal reference is not known
Claim.item.encounter.display 0..0 Text alternative for the resource
Claim.item.detail
Claim.item.detail.unitPrice 0..0 Fee, charge or cost per item
Claim.item.detail.net 0..0 Total item cost
Claim.item.detail.subDetail
Claim.item.detail.subDetail.unitPrice 0..0 Fee, charge or cost per item
Claim.item.detail.subDetail.net 0..0 Total item cost
Claim.total 0..0 Total claim cost

doco 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

Constraints

Id Grade Path(s) Description Expression
allowedLocalIdentifierSystems error Claim.provider.identifier.system, Claim.item.location[x]:locationReference.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 $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
full-datetime-with-timezone error Claim.billablePeriod.start, Claim.billablePeriod.end, Claim.created, Claim.item.serviced[x].start, Claim.item.serviced[x].end DateTime must be ISO 8601 format with time and timezone (e.g., 2026-01-01T00:00:00+13:00 or 2026-01-01T00:00:00Z). Date-only values are not accepted. toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}T[0-9]{2}:[0-9]{2}:[0-9]{2}(\\.[0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
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]$')
hpiCpnPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.identifier HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic). system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.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]$')
hpiOrganizationIdPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.identifier HPI Organisation ID must conform to format (GXXnnn-C). system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
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})$')
nzbnPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.identifier NZBN must conform to format (13 digits). system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')
unique-claim-item-sequence error Claim Each item.sequence must be unique within the Claim item.sequence.isDistinct()

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Claim C 0..* Claim Claim, Pre-determination or Pre-authorization
Constraints: unique-claim-item-sequence
Claim.id This element is included in summaries. 0..1 id Logical id of this artifact
Claim.meta 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 This element is included in summaries. 0..1 id Version specific identifier
Claim.meta.lastUpdated This element is included in summaries. 0..1 instant When the resource version last changed
Claim.meta.source 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 This element is included in summaries. 1..1 canonical(StructureDefinition) Profiles this resource claims to conform to
Claim.meta.security 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 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 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 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 This element is included in summaries. 0..1 string Version of the system - if relevant
Claim.meta.Slices for tag.tag:correlationId.code This element is included in summaries. 1..1 code Symbol in syntax defined by the system
Claim.meta.Slices for tag.tag:correlationId.display This element is included in summaries. 0..1 string Representation defined by the system
Claim.meta.Slices for tag.tag:correlationId.userSelected 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. 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 BindingsPurpose
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:traceNumber 0..* Identifier Shared Care Claim Trace Number
URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
Claim.Slices for extension.extension:agreementNumber 1..1 string Shared Care Agreement Number
URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-agreement-number
Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Claim.identifier 0..* Identifier Business identifier(s) for the 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. 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 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 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 This element is included in summaries. 1..1 string The value that is unique
Example General: 123456
Claim.identifier.period This element is included in summaries. 0..1 Period Time period when id is/was valid for use
Claim.identifier.assigner 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. 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 This element is included in summaries. 1..1 CodeableConcept Claim type
Binding: NZ Claim Types (extensible)
Claim.subType 0..1 CodeableConcept Claim subtype
Binding: NZ Claim Subtypes (extensible)
Claim.use 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 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 This element is included in summaries. C 0..1 string Literal reference, Relative, internal or absolute URL
Claim.patient.type 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 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. 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 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 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 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 This element is included in summaries. 0..1 Period Time period when id is/was valid for use
Claim.patient.identifier.assigner This element is included in summaries. 0..1 Reference(Organization) Organization that issued id (may be just text)
Claim.billablePeriod This element is included in summaries. 1..1 Period Billing period with datetime including timezone (start is inclusive, end is exclusive)
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 This element is included in summaries. C 0..1 dateTime Starting time with inclusive boundary
Constraints: full-datetime-with-timezone
Claim.billablePeriod.end This element is included in summaries. C 0..1 dateTime End time with inclusive boundary, if not ongoing
Constraints: full-datetime-with-timezone
Claim.created 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 This element is included in summaries. 1..1 Reference(Organization) Legal entity who submitted 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 This element is included in summaries. C 0..1 string Literal reference, Relative, internal or absolute URL
Claim.provider.type 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 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. 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 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 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 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 This element is included in summaries. 0..1 Period Time period when id is/was valid for use
Claim.provider.identifier.assigner This element is included in summaries. 0..1 Reference(Organization) Organization that issued id (may be just text)
Claim.provider.display This element is included in summaries. 0..1 string Text alternative for the resource
Claim.priority This element is included in summaries. 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
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. 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 Additional attributes that may accompany a Claim
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. 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 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. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence This element is included in summaries. 1..1 positiveInt Insurance instance identifier
Claim.insurance.focal 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 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 0..* BackboneElement Each individual product or service being claimed for as part of this claim
Claim.item.id 0..1 string Unique id for inter-element referencing
Claim.item.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.Slices for extension.extension:patientPaid 0..1 Money Shared Care Patient Copayment
URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-patient-copayment
Claim.item.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Claim.item.sequence This element must be supported. 1..1 positiveInt Referred to by the ClaimResponse.item.itemSequence
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.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.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.productOrService 1..1 CodeableConcept Product or service being claimed (e.g., PU code)
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.serviced[x] 0..1 Period When the claimed event started and ended
Claim.item.serviced[x].id 0..1 string Unique id for inter-element referencing
Claim.item.serviced[x].extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.item.serviced[x].start This element is included in summaries. C 0..1 dateTime Starting time with inclusive boundary
Constraints: full-datetime-with-timezone
Claim.item.serviced[x].end This element is included in summaries. C 0..1 dateTime End time with inclusive boundary, if not ongoing
Constraints: full-datetime-with-timezone
Claim.item.Slices for location[x] 0..1 Place of service or where product was supplied
Slice: Unordered, Closed by type:$this
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them Other type slices that contain no new information are not shown in this view
Claim.item.Slices for location[x].locationCodeableConcept CodeableConcept
Claim.item.Slices for location[x].locationAddress Address
Claim.item.Slices for location[x].locationReference Reference(Location)
Claim.item.Slices for location[x].location[x]:locationReference 0..1 Reference(Location) HPI Facility
Claim.item.Slices for location[x].location[x]:locationReference.id 0..1 string Unique id for inter-element referencing
Claim.item.Slices for location[x].location[x]:locationReference.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.item.Slices for location[x].location[x]:locationReference.reference This element is included in summaries. C 0..1 string Literal reference, Relative, internal or absolute URL
Claim.item.Slices for location[x].location[x]:locationReference.type 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.item.Slices for location[x].location[x]:locationReference.identifier 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.item.Slices for location[x].location[x]:locationReference.identifier.id 0..1 string Unique id for inter-element referencing
Claim.item.Slices for location[x].location[x]:locationReference.identifier.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.item.Slices for location[x].location[x]:locationReference.identifier.use This element is a modifier element. 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.item.Slices for location[x].location[x]:locationReference.identifier.type 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.item.Slices for location[x].location[x]:locationReference.identifier.system 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.item.Slices for location[x].location[x]:locationReference.identifier.value 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.item.Slices for location[x].location[x]:locationReference.identifier.period This element is included in summaries. 0..1 Period Time period when id is/was valid for use
Claim.item.Slices for location[x].location[x]:locationReference.identifier.assigner This element is included in summaries. 0..1 Reference(Organization) Organization that issued id (may be just text)
Claim.item.Slices for location[x].location[x]:locationReference.display This element is included in summaries. 0..1 string Text alternative for the resource
Claim.item.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.item.factor 0..1 decimal Price scaling factor
Claim.item.udi 0..* Reference(Device) Unique device identifier
Claim.item.bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
Claim.item.subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
Claim.item.encounter 0..* Reference(Encounter) Encounters related to this billed item
Claim.item.encounter.id 0..1 string Unique id for inter-element referencing
Claim.item.encounter.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Claim.item.encounter.reference This element is included in summaries. C 1..1 string Literal reference, Relative, internal or absolute URL
Claim.item.encounter.type 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.item.detail 0..* BackboneElement Product or service provided
Claim.item.detail.id 0..1 string Unique id for inter-element referencing
Claim.item.detail.extension 0..* Extension Additional content defined by implementations
Claim.item.detail.modifierExtension This element is a modifier element. 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.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.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.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.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.detail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1
Claim.item.detail.factor 0..1 decimal Price scaling factor
Claim.item.detail.udi 0..* Reference(Device) Unique device identifier
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. 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.factor 0..1 decimal Price scaling factor
Claim.item.detail.subDetail.udi 0..* Reference(Device) Unique device identifier

doco 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 example 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.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item.location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
Claim.item.location[x]:locationReference.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
Claim.item.location[x]:locationReference.​identifier.use Base required IdentifierUse 📍4.0.1 FHIR Std.
Claim.item.location[x]:locationReference.​identifier.type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Claim.item.location[x]:locationCodeableConcept Base example Example Service Place Codes 📍4.0.1 FHIR Std.
Claim.item.bodySite Base example Oral Site Codes 📍4.0.1 FHIR Std.
Claim.item.subSite Base example Surface Codes 📍4.0.1 FHIR Std.
Claim.item.encounter.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
Claim.item.detail.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item.detail.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item.detail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item.detail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item.detail.programCode Base example Example Program Reason 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, Claim.item.location[x]:locationReference.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 $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
full-datetime-with-timezone error Claim.billablePeriod.start, Claim.billablePeriod.end, Claim.created, Claim.item.serviced[x].start, Claim.item.serviced[x].end DateTime must be ISO 8601 format with time and timezone (e.g., 2026-01-01T00:00:00+13:00 or 2026-01-01T00:00:00Z). Date-only values are not accepted. toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}T[0-9]{2}:[0-9]{2}:[0-9]{2}(\\.[0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
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]$')
hpiCpnPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.identifier HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic). system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.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]$')
hpiOrganizationIdPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.identifier HPI Organisation ID must conform to format (GXXnnn-C). system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
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})$')
nzbnPattern error Claim.provider.identifier, Claim.item.location[x]:locationReference.identifier NZBN must conform to format (13 digits). system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')
unique-claim-item-sequence error Claim Each item.sequence must be unique within the Claim item.sequence.isDistinct()

This structure is derived from Claim

Summary

Mandatory: 17 elements(6 nested mandatory elements)
Must-Support: 1 element
Fixed: 1 element
Prohibited: 20 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

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.location[x]

 

Other representations of profile: CSV, Excel, Schematron