SA Claim - HSAAP Special Authority FHIR Implementation Guide v0.1.1

HSAAP Special Authority FHIR Implementation Guide - Local Development build (v0.1.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: SA Claim

Official URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/sa-claim				Version: 0.1.1
Draft as of 2026-10-16				Computable Name: SAClaim

A Special Authority Application: a request for authorisation of funded pharmaceuticals in advance of their supply, i.e. a Claim with use = preauthorization. Submitted inside an SA Submission Bundle to Claim/$submit.

The clinical criteria and answers are carried by the QuestionnaireResponse referenced from supportingInfo.
provider references the Applicant - the same Practitioner as QuestionnaireResponse.author. FHIR R4 Claim has no requestor element; the custom requestor search parameter evaluates Claim.provider, so requestor:Practitioner.identifier searches and _include=Claim:requestor resolve to the Applicant.
identifier carries the Application Number only (D23). It is absent on submission and is populated by the API.
item is used only for NPPA and panel approval Applications, where no form declares coverage. Standard Special Authority Applications SHALL NOT supply item; coverage is derived from the resolved form at decision time (D6).
Financial elements are constrained out. Monetary amounts are never present.
insurance is mandatory in FHIR R4 Claim. It carries a logical reference to the Pharmaceutical Schedule and has no other meaning (see Design Notes).

Usages:

Use this Profile: SA Submission Bundle
Refer to this Profile: SA Application ClaimResponse and SA Approval ClaimResponse
Examples for this Profile: Claim/sa-example-claim-nppa and Claim/sa-example-claim
CapabilityStatements using this Profile: Special Authority FHIR Server Capability Statement

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

Key Elements Table
Differential Table
Snapshot Table
Statistics/References
All

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
Claim.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		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.Slices for extension.extension:submissionContext	This element must be supported.	0..1	(Complex)	Asserted source context - provenance only URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/submission-context
Claim.Slices for extension.extension:applicationStatus	This element must be supported. C	0..1	(Complex)	Populated by the API on Application Enquiry. SHALL NOT be sent on submission. URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status Constraints: sa-appstatus-1
Claim.modifierExtension	This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.identifier	This element must be supported.	0..1	Identifier	Application Number - populated by the API, absent on submission
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 Fixed Value: https://fhir-ig.digital.health.nz/special-authority/ns/application-number (no extensions allowed)
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. Required Pattern: active (extensions allowed)
Claim.type	This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Required Pattern: `{ "coding" : [ { "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "pharmacy" } ] }`
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. Required Pattern: preauthorization (extensions allowed)
Claim.patient	This element must be supported. This element is included in summaries.	1..1	Reference(SA Patient)	The recipient of the products and services
Claim.created	This element must be supported. This element is included in summaries.	1..1	dateTime	Resource creation date
Claim.provider	This element must be supported. This element is included in summaries.	1..1	Reference(SA Practitioner)	The Applicant - same Practitioner as QuestionnaireResponse.author
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. Required Pattern: `{ "coding" : [ { "system" : "http://terminology.hl7.org/CodeSystem/processpriority", "code" : "normal" } ] }`
Claim.Slices for supportingInfo	This element must be supported.	1..*	BackboneElement	Supporting information Slice: Unordered, Open by pattern:category Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:All Slices				Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:All Slices.modifierExtension	This element is a modifier element. This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:All Slices.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:All Slices.category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse	This element must be supported.	1..1	BackboneElement	Supporting information
Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse.modifierExtension	This element is a modifier element. This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse.category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: `{ "coding" : [ { "system" : "https://fhir-ig.digital.health.nz/special-authority/CodeSystem/sa-supporting-info-category", "code" : "questionnaire-response" } ] }`
Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse.value[x]	This element must be supported.	1..1	Reference(SA QuestionnaireResponse)	Data to be provided
Claim.insurance	This element is included in summaries.	1..1	BackboneElement	Mandatory in FHIR R4 - logical reference to the Pharmaceutical Schedule only
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 Required Pattern: 1 (extensions allowed)
Claim.insurance.focal	This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication Fixed Value: true (no extensions allowed)
Claim.insurance.coverage	This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Claim.insurance.coverage.display	This element is included in summaries.	1..1	string	Text alternative for the resource Required Pattern: Pharmaceutical Schedule (extensions allowed)
Claim.item	This element must be supported. C	0..*	BackboneElement	Requested pharmaceuticals - NPPA and panel approval Applications only Constraints: sa-claim-1
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		1..1	positiveInt	Item instance identifier
Claim.item.productOrService	This element must be supported.	1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.productOrService.Slices for coding	This element must be supported. This element is included in summaries.	1..*	Coding	Code defined by a terminology system 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.item.productOrService.Slices for coding.coding:ctpp	This element must be supported. This element is included in summaries.	0..1	Coding	NZMT CTPP ID (preferred)
Claim.item.productOrService.Slices for coding.coding:ctpp.system	This element is included in summaries.	1..1	uri	Identity of the terminology system Fixed Value: http://nzmt.org.nz (no extensions allowed)
Claim.item.productOrService.Slices for coding.coding:ctpp.code	This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.item.productOrService.Slices for coding.coding:ctpp.display	This element must be supported. This element is included in summaries.	0..1	string	Representation defined by the system
Claim.item.productOrService.Slices for coding.coding:pharmacode	This element must be supported. This element is included in summaries.	0..1	Coding	Pharmac Pharmacode
Claim.item.productOrService.Slices for coding.coding:pharmacode.system	This element is included in summaries.	1..1	uri	Identity of the terminology system Fixed Value: https://fhir-ig.digital.health.nz/special-authority/ns/pharmacode (no extensions allowed)
Claim.item.productOrService.Slices for coding.coding:pharmacode.code	This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.item.productOrService.Slices for coding.coding:pharmacode.display	This element must be supported. This element is included in summaries.	0..1	string	Representation defined by the system
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
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	Claim Type Codes	📍4.0.1	FHIR Std.
Claim.use	Base	required	Use	📍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.supportingInfo:questionnaireResponse.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.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
sa-claim-1	error	Claim.item	A requested pharmaceutical SHALL be identified by a CTPP ID or a Pharmacode.	`productOrService.coding.where(system = 'http://nzmt.org.nz' or system = 'https://fhir-ig.digital.health.nz/special-authority/ns/pharmacode').exists()`

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
Claim.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.Slices for extension.extension:submissionContext	This element must be supported.	0..1	(Complex)	Asserted source context - provenance only URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/submission-context
Claim.Slices for extension.extension:applicationStatus	This element must be supported.	0..1	(Complex)	Populated by the API on Application Enquiry. SHALL NOT be sent on submission. URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status
Claim.identifier	This element must be supported.	0..1	Identifier	Application Number - populated by the API, absent on submission
Claim.identifier.system		1..1	uri	The namespace for the identifier value Fixed Value: https://fhir-ig.digital.health.nz/special-authority/ns/application-number (no extensions allowed)
Claim.identifier.value		1..1	string	The value that is unique
Claim.status		1..1	code	active \| cancelled \| draft \| entered-in-error Required Pattern: active (extensions allowed)
Claim.type		1..1	CodeableConcept	Category or discipline Required Pattern: `{ "coding" : [ { "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "pharmacy" } ] }`
Claim.subType		0..0		More granular claim type
Claim.use		1..1	code	claim \| preauthorization \| predetermination Required Pattern: preauthorization (extensions allowed)
Claim.patient	This element must be supported.	1..1	Reference(SA Patient)	The recipient of the products and services
Claim.billablePeriod		0..0		Relevant time frame for the claim
Claim.created	This element must be supported.	1..1	dateTime	Resource creation date
Claim.enterer		0..0		Author of the claim
Claim.insurer		0..0		Target
Claim.provider	This element must be supported.	1..1	Reference(SA Practitioner)	The Applicant - same Practitioner as QuestionnaireResponse.author
Claim.priority		1..1	CodeableConcept	Desired processing ugency Required Pattern: `{ "coding" : [ { "system" : "http://terminology.hl7.org/CodeSystem/processpriority", "code" : "normal" } ] }`
Claim.fundsReserve		0..0		For whom to reserve funds
Claim.related		0..0		Prior or corollary claims
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.referral		0..0		Treatment referral
Claim.facility		0..0		Servicing facility
Claim.careTeam		0..0		Members of the care team
Claim.Slices for supportingInfo	This element must be supported.	1..*	BackboneElement	Supporting information Slice: Unordered, Open by pattern:category Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse	This element must be supported.	1..1	BackboneElement	Supporting information
Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse.category		1..1	CodeableConcept	Classification of the supplied information Required Pattern: `{ "coding" : [ { "system" : "https://fhir-ig.digital.health.nz/special-authority/CodeSystem/sa-supporting-info-category", "code" : "questionnaire-response" } ] }`
Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse.value[x]	This element must be supported.	1..1	Reference(SA QuestionnaireResponse)	Data to be provided
Claim.diagnosis		0..0		Pertinent diagnosis information
Claim.procedure		0..0		Clinical procedures performed
Claim.insurance		1..1	BackboneElement	Mandatory in FHIR R4 - logical reference to the Pharmaceutical Schedule only
Claim.insurance.sequence		1..1	positiveInt	Insurance instance identifier Required Pattern: 1 (extensions allowed)
Claim.insurance.focal		1..1	boolean	Coverage to be used for adjudication Fixed Value: true (no extensions allowed)
Claim.insurance.identifier		0..0		Pre-assigned Claim number
Claim.insurance.coverage
Claim.insurance.coverage.reference		0..0		Literal reference, Relative, internal or absolute URL
Claim.insurance.coverage.display		1..1	string	Text alternative for the resource Required Pattern: Pharmaceutical Schedule (extensions allowed)
Claim.insurance.businessArrangement		0..0		Additional provider contract number
Claim.insurance.preAuthRef		0..0		Prior authorization reference number
Claim.insurance.claimResponse		0..0		Adjudication results
Claim.accident		0..0		Details of the event
Claim.item	This element must be supported. C	0..*	BackboneElement	Requested pharmaceuticals - NPPA and panel approval Applications only Constraints: sa-claim-1
Claim.item.careTeamSequence		0..0		Applicable careTeam members
Claim.item.diagnosisSequence		0..0		Applicable diagnoses
Claim.item.procedureSequence		0..0		Applicable procedures
Claim.item.informationSequence		0..0		Applicable exception and supporting information
Claim.item.revenue		0..0		Revenue or cost center code
Claim.item.category		0..0		Benefit classification
Claim.item.productOrService	This element must be supported.	1..1	CodeableConcept	Billing, service, product, or drug code
Claim.item.productOrService.Slices for coding	This element must be supported.	1..*	Coding	Code defined by a terminology system 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.item.productOrService.Slices for coding.coding:ctpp	This element must be supported.	0..1	Coding	NZMT CTPP ID (preferred)
Claim.item.productOrService.Slices for coding.coding:ctpp.system		1..1	uri	Identity of the terminology system Fixed Value: http://nzmt.org.nz (no extensions allowed)
Claim.item.productOrService.Slices for coding.coding:ctpp.code		1..1	code	Symbol in syntax defined by the system
Claim.item.productOrService.Slices for coding.coding:ctpp.display	This element must be supported.	0..1	string	Representation defined by the system
Claim.item.productOrService.Slices for coding.coding:pharmacode	This element must be supported.	0..1	Coding	Pharmac Pharmacode
Claim.item.productOrService.Slices for coding.coding:pharmacode.system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir-ig.digital.health.nz/special-authority/ns/pharmacode (no extensions allowed)
Claim.item.productOrService.Slices for coding.coding:pharmacode.code		1..1	code	Symbol in syntax defined by the system
Claim.item.productOrService.Slices for coding.coding:pharmacode.display	This element must be supported.	0..1	string	Representation defined by the system
Claim.item.modifier		0..0		Product or service billing modifiers
Claim.item.programCode		0..0		Program the product or service is provided under
Claim.item.serviced[x]		0..0		Date or dates of service or product delivery
Claim.item.location[x]		0..0		Place of service or where product was supplied
Claim.item.unitPrice		0..0		Fee, charge or cost per item
Claim.item.factor		0..0		Price scaling factor
Claim.item.net		0..0		Total item cost
Claim.item.udi		0..0		Unique device identifier
Claim.item.bodySite		0..0		Anatomical location
Claim.item.subSite		0..0		Anatomical sub-location
Claim.item.encounter		0..0		Encounters related to this billed item
Claim.item.detail		0..0		Product or service provided
Claim.total		0..0		Total claim cost
Documentation for this format

Constraints

Id	Grade	Path(s)	Description	Expression
sa-claim-1	error	Claim.item	A requested pharmaceutical SHALL be identified by a CTPP ID or a Pharmacode.	`productOrService.coding.where(system = 'http://nzmt.org.nz' or system = 'https://fhir-ig.digital.health.nz/special-authority/ns/pharmacode').exists()`

Description & Constraints Filter:

Claim 0..* Claim Claim, Pre-determination or Pre-authorization

Claim.id This element is included in summaries. 0..1 id Logical id of this artifact

Claim.meta This element is included in summaries. 0..1 Meta Metadata about the resource

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

language

0..1

code

Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional Bindings

Purpose

AllLanguages

Max Binding

Claim.text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements

Claim.contained 0..* Resource Contained, inline Resources

Claim.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.Slices for extension.extension:submissionContext This element must be supported. 0..1 (Complex) Asserted source context - provenance only
URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/submission-context

Claim.Slices for extension.extension:applicationStatus This element must be supported. C 0..1 (Complex) Populated by the API on Application Enquiry. SHALL NOT be sent on submission.
URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status
Constraints: sa-appstatus-1

Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored

Claim.identifier This element must be supported. 0..1 Identifier Application Number - populated by the API, absent on submission

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
Fixed Value: https://fhir-ig.digital.health.nz/special-authority/ns/application-number (no extensions allowed)

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.
Required Pattern: active (extensions allowed)

type

1..1

CodeableConcept

Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Required Pattern:

{
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "pharmacy"
    }
  ]
}

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.
Required Pattern: preauthorization (extensions allowed)

Claim.patient This element must be supported. This element is included in summaries. 1..1 Reference(SA Patient) The recipient of the products and services

Claim.created This element must be supported. This element is included in summaries. 1..1 dateTime Resource creation date

Claim.provider This element must be supported. This element is included in summaries. 1..1 Reference(SA Practitioner) The Applicant - same Practitioner as QuestionnaireResponse.author

priority

1..1

CodeableConcept

Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Required Pattern:

{
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
      "code" : "normal"
    }
  ]
}

Claim.Slices for supportingInfo This element must be supported. 1..* BackboneElement Supporting information
Slice: Unordered, Open by pattern:category

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

Claim.Slices for supportingInfo.supportingInfo:All Slices Content/Rules for all slices

Claim.Slices for supportingInfo.supportingInfo:All Slices.id 0..1 string Unique id for inter-element referencing

Claim.Slices for supportingInfo.supportingInfo:All Slices.extension 0..* Extension Additional content defined by implementations

Claim.Slices for supportingInfo.supportingInfo:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Claim.Slices for supportingInfo.supportingInfo:All Slices.sequence 1..1 positiveInt Information instance identifier

Claim.Slices for supportingInfo.supportingInfo:All Slices.category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.

Claim.Slices for supportingInfo.supportingInfo:All Slices.code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x] 0..1 When it occurred

Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x].timingDate date

Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x].timingPeriod Period

Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x] 0..1 Data to be provided

Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueBoolean boolean

Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueString string

Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueQuantity Quantity

Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueAttachment Attachment

Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueReference Reference(Resource)

Claim.Slices for supportingInfo.supportingInfo:All Slices.reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse This element must be supported. 1..1 BackboneElement Supporting information

Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse.id 0..1 string Unique id for inter-element referencing

Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse.extension 0..* Extension Additional content defined by implementations

Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse.sequence 1..1 positiveInt Information instance identifier

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
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	Claim Type Codes	📍4.0.1	FHIR Std.
Claim.use	Base	required	Use	📍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.supportingInfo:questionnaireResponse.category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:questionnaireResponse.code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:questionnaireResponse.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.insurance.coverage.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.accident.type	Base	extensible	ActIncidentCode	📦3.0.0	THO v7.4
Claim.item.productOrService	Base	example	USCLS Codes	📍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
sa-claim-1	error	Claim.item	A requested pharmaceutical SHALL be identified by a CTPP ID or a Pharmacode.	`productOrService.coding.where(system = 'http://nzmt.org.nz' or system = 'https://fhir-ig.digital.health.nz/special-authority/ns/pharmacode').exists()`

This structure is derived from Claim

Summary

Mandatory: 4 elements(7 nested mandatory elements)
Must-Support: 16 elements
Fixed: 4 elements
Prohibited: 39 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.supportingInfo
The element 1 is sliced based on the value of Claim.item.productOrService.coding

Key Elements View

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
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		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.Slices for extension.extension:submissionContext	This element must be supported.	0..1	(Complex)	Asserted source context - provenance only URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/submission-context
Claim.Slices for extension.extension:applicationStatus	This element must be supported. C	0..1	(Complex)	Populated by the API on Application Enquiry. SHALL NOT be sent on submission. URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status Constraints: sa-appstatus-1
Claim.modifierExtension	This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.identifier	This element must be supported.	0..1	Identifier	Application Number - populated by the API, absent on submission
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 Fixed Value: https://fhir-ig.digital.health.nz/special-authority/ns/application-number (no extensions allowed)
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. Required Pattern: active (extensions allowed)
Claim.type	This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Required Pattern: `{ "coding" : [ { "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "pharmacy" } ] }`
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. Required Pattern: preauthorization (extensions allowed)
Claim.patient	This element must be supported. This element is included in summaries.	1..1	Reference(SA Patient)	The recipient of the products and services
Claim.created	This element must be supported. This element is included in summaries.	1..1	dateTime	Resource creation date
Claim.provider	This element must be supported. This element is included in summaries.	1..1	Reference(SA Practitioner)	The Applicant - same Practitioner as QuestionnaireResponse.author
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. Required Pattern: `{ "coding" : [ { "system" : "http://terminology.hl7.org/CodeSystem/processpriority", "code" : "normal" } ] }`
Claim.Slices for supportingInfo	This element must be supported.	1..*	BackboneElement	Supporting information Slice: Unordered, Open by pattern:category Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:All Slices				Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:All Slices.modifierExtension	This element is a modifier element. This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:All Slices.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:All Slices.category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse	This element must be supported.	1..1	BackboneElement	Supporting information
Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse.modifierExtension	This element is a modifier element. This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse.category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: `{ "coding" : [ { "system" : "https://fhir-ig.digital.health.nz/special-authority/CodeSystem/sa-supporting-info-category", "code" : "questionnaire-response" } ] }`
Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse.value[x]	This element must be supported.	1..1	Reference(SA QuestionnaireResponse)	Data to be provided
Claim.insurance	This element is included in summaries.	1..1	BackboneElement	Mandatory in FHIR R4 - logical reference to the Pharmaceutical Schedule only
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 Required Pattern: 1 (extensions allowed)
Claim.insurance.focal	This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication Fixed Value: true (no extensions allowed)
Claim.insurance.coverage	This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Claim.insurance.coverage.display	This element is included in summaries.	1..1	string	Text alternative for the resource Required Pattern: Pharmaceutical Schedule (extensions allowed)
Claim.item	This element must be supported. C	0..*	BackboneElement	Requested pharmaceuticals - NPPA and panel approval Applications only Constraints: sa-claim-1
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		1..1	positiveInt	Item instance identifier
Claim.item.productOrService	This element must be supported.	1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.productOrService.Slices for coding	This element must be supported. This element is included in summaries.	1..*	Coding	Code defined by a terminology system 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.item.productOrService.Slices for coding.coding:ctpp	This element must be supported. This element is included in summaries.	0..1	Coding	NZMT CTPP ID (preferred)
Claim.item.productOrService.Slices for coding.coding:ctpp.system	This element is included in summaries.	1..1	uri	Identity of the terminology system Fixed Value: http://nzmt.org.nz (no extensions allowed)
Claim.item.productOrService.Slices for coding.coding:ctpp.code	This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.item.productOrService.Slices for coding.coding:ctpp.display	This element must be supported. This element is included in summaries.	0..1	string	Representation defined by the system
Claim.item.productOrService.Slices for coding.coding:pharmacode	This element must be supported. This element is included in summaries.	0..1	Coding	Pharmac Pharmacode
Claim.item.productOrService.Slices for coding.coding:pharmacode.system	This element is included in summaries.	1..1	uri	Identity of the terminology system Fixed Value: https://fhir-ig.digital.health.nz/special-authority/ns/pharmacode (no extensions allowed)
Claim.item.productOrService.Slices for coding.coding:pharmacode.code	This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.item.productOrService.Slices for coding.coding:pharmacode.display	This element must be supported. This element is included in summaries.	0..1	string	Representation defined by the system
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
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	Claim Type Codes	📍4.0.1	FHIR Std.
Claim.use	Base	required	Use	📍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.supportingInfo:questionnaireResponse.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.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
sa-claim-1	error	Claim.item	A requested pharmaceutical SHALL be identified by a CTPP ID or a Pharmacode.	`productOrService.coding.where(system = 'http://nzmt.org.nz' or system = 'https://fhir-ig.digital.health.nz/special-authority/ns/pharmacode').exists()`

Differential View

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
Claim.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.Slices for extension.extension:submissionContext	This element must be supported.	0..1	(Complex)	Asserted source context - provenance only URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/submission-context
Claim.Slices for extension.extension:applicationStatus	This element must be supported.	0..1	(Complex)	Populated by the API on Application Enquiry. SHALL NOT be sent on submission. URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status
Claim.identifier	This element must be supported.	0..1	Identifier	Application Number - populated by the API, absent on submission
Claim.identifier.system		1..1	uri	The namespace for the identifier value Fixed Value: https://fhir-ig.digital.health.nz/special-authority/ns/application-number (no extensions allowed)
Claim.identifier.value		1..1	string	The value that is unique
Claim.status		1..1	code	active \| cancelled \| draft \| entered-in-error Required Pattern: active (extensions allowed)
Claim.type		1..1	CodeableConcept	Category or discipline Required Pattern: `{ "coding" : [ { "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "pharmacy" } ] }`
Claim.subType		0..0		More granular claim type
Claim.use		1..1	code	claim \| preauthorization \| predetermination Required Pattern: preauthorization (extensions allowed)
Claim.patient	This element must be supported.	1..1	Reference(SA Patient)	The recipient of the products and services
Claim.billablePeriod		0..0		Relevant time frame for the claim
Claim.created	This element must be supported.	1..1	dateTime	Resource creation date
Claim.enterer		0..0		Author of the claim
Claim.insurer		0..0		Target
Claim.provider	This element must be supported.	1..1	Reference(SA Practitioner)	The Applicant - same Practitioner as QuestionnaireResponse.author
Claim.priority		1..1	CodeableConcept	Desired processing ugency Required Pattern: `{ "coding" : [ { "system" : "http://terminology.hl7.org/CodeSystem/processpriority", "code" : "normal" } ] }`
Claim.fundsReserve		0..0		For whom to reserve funds
Claim.related		0..0		Prior or corollary claims
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.referral		0..0		Treatment referral
Claim.facility		0..0		Servicing facility
Claim.careTeam		0..0		Members of the care team
Claim.Slices for supportingInfo	This element must be supported.	1..*	BackboneElement	Supporting information Slice: Unordered, Open by pattern:category Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse	This element must be supported.	1..1	BackboneElement	Supporting information
Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse.category		1..1	CodeableConcept	Classification of the supplied information Required Pattern: `{ "coding" : [ { "system" : "https://fhir-ig.digital.health.nz/special-authority/CodeSystem/sa-supporting-info-category", "code" : "questionnaire-response" } ] }`
Claim.Slices for supportingInfo.supportingInfo:questionnaireResponse.value[x]	This element must be supported.	1..1	Reference(SA QuestionnaireResponse)	Data to be provided
Claim.diagnosis		0..0		Pertinent diagnosis information
Claim.procedure		0..0		Clinical procedures performed
Claim.insurance		1..1	BackboneElement	Mandatory in FHIR R4 - logical reference to the Pharmaceutical Schedule only
Claim.insurance.sequence		1..1	positiveInt	Insurance instance identifier Required Pattern: 1 (extensions allowed)
Claim.insurance.focal		1..1	boolean	Coverage to be used for adjudication Fixed Value: true (no extensions allowed)
Claim.insurance.identifier		0..0		Pre-assigned Claim number
Claim.insurance.coverage
Claim.insurance.coverage.reference		0..0		Literal reference, Relative, internal or absolute URL
Claim.insurance.coverage.display		1..1	string	Text alternative for the resource Required Pattern: Pharmaceutical Schedule (extensions allowed)
Claim.insurance.businessArrangement		0..0		Additional provider contract number
Claim.insurance.preAuthRef		0..0		Prior authorization reference number
Claim.insurance.claimResponse		0..0		Adjudication results
Claim.accident		0..0		Details of the event
Claim.item	This element must be supported. C	0..*	BackboneElement	Requested pharmaceuticals - NPPA and panel approval Applications only Constraints: sa-claim-1
Claim.item.careTeamSequence		0..0		Applicable careTeam members
Claim.item.diagnosisSequence		0..0		Applicable diagnoses
Claim.item.procedureSequence		0..0		Applicable procedures
Claim.item.informationSequence		0..0		Applicable exception and supporting information
Claim.item.revenue		0..0		Revenue or cost center code
Claim.item.category		0..0		Benefit classification
Claim.item.productOrService	This element must be supported.	1..1	CodeableConcept	Billing, service, product, or drug code
Claim.item.productOrService.Slices for coding	This element must be supported.	1..*	Coding	Code defined by a terminology system 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.item.productOrService.Slices for coding.coding:ctpp	This element must be supported.	0..1	Coding	NZMT CTPP ID (preferred)
Claim.item.productOrService.Slices for coding.coding:ctpp.system		1..1	uri	Identity of the terminology system Fixed Value: http://nzmt.org.nz (no extensions allowed)
Claim.item.productOrService.Slices for coding.coding:ctpp.code		1..1	code	Symbol in syntax defined by the system
Claim.item.productOrService.Slices for coding.coding:ctpp.display	This element must be supported.	0..1	string	Representation defined by the system
Claim.item.productOrService.Slices for coding.coding:pharmacode	This element must be supported.	0..1	Coding	Pharmac Pharmacode
Claim.item.productOrService.Slices for coding.coding:pharmacode.system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir-ig.digital.health.nz/special-authority/ns/pharmacode (no extensions allowed)
Claim.item.productOrService.Slices for coding.coding:pharmacode.code		1..1	code	Symbol in syntax defined by the system
Claim.item.productOrService.Slices for coding.coding:pharmacode.display	This element must be supported.	0..1	string	Representation defined by the system
Claim.item.modifier		0..0		Product or service billing modifiers
Claim.item.programCode		0..0		Program the product or service is provided under
Claim.item.serviced[x]		0..0		Date or dates of service or product delivery
Claim.item.location[x]		0..0		Place of service or where product was supplied
Claim.item.unitPrice		0..0		Fee, charge or cost per item
Claim.item.factor		0..0		Price scaling factor
Claim.item.net		0..0		Total item cost
Claim.item.udi		0..0		Unique device identifier
Claim.item.bodySite		0..0		Anatomical location
Claim.item.subSite		0..0		Anatomical sub-location
Claim.item.encounter		0..0		Encounters related to this billed item
Claim.item.detail		0..0		Product or service provided
Claim.total		0..0		Total claim cost
Documentation for this format

Constraints

Id	Grade	Path(s)	Description	Expression
sa-claim-1	error	Claim.item	A requested pharmaceutical SHALL be identified by a CTPP ID or a Pharmacode.	`productOrService.coding.where(system = 'http://nzmt.org.nz' or system = 'https://fhir-ig.digital.health.nz/special-authority/ns/pharmacode').exists()`

Snapshot View

Description & Constraints Filter:

Claim 0..* Claim Claim, Pre-determination or Pre-authorization

Claim.id This element is included in summaries. 0..1 id Logical id of this artifact

Claim.meta This element is included in summaries. 0..1 Meta Metadata about the resource

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

language

0..1

code

Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional Bindings

Purpose

AllLanguages

Max Binding

Claim.text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements

Claim.contained 0..* Resource Contained, inline Resources

Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored

Claim.identifier This element must be supported. 0..1 Identifier Application Number - populated by the API, absent on submission

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.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)

type

1..1

CodeableConcept

Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Required Pattern:

{
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "pharmacy"
    }
  ]
}

Claim.patient This element must be supported. This element is included in summaries. 1..1 Reference(SA Patient) The recipient of the products and services

Claim.created This element must be supported. This element is included in summaries. 1..1 dateTime Resource creation date

Claim.provider This element must be supported. This element is included in summaries. 1..1 Reference(SA Practitioner) The Applicant - same Practitioner as QuestionnaireResponse.author

priority

1..1

CodeableConcept

Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Required Pattern:

{
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
      "code" : "normal"
    }
  ]
}