Belgian MyCareNet Profiles
2.0.0 - STU
Belgian MyCareNet Profiles
2.0.0 - STU
This page is part of the HL7 Belgium FHIR Implementation Guide - MyCareNet profiles (v2.0.0: Trial Use) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.1.0. For a full list of available versions, see the Directory of published versions
| Official URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaim | Version: 2.0.0 | |||
| Active as of 2023-04-27 | Computable Name: BeMyCareNetEagreementClaim | |||
Claim profile for use in the different eAgreement flow from MyCareNet.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Claim
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization be-rule-eagreementclaim-1: Billable period start and end SHALL be YYYY-MM-DD be-rule-eagreementclaim-2: Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz |
  id | S | 1..1 | id | Logical id of this artifact |
 meta | S | 1..1 | Meta | Metadata about the resource |
  profile | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | |
| status | S | 1..1 | code | active | cancelled | draft | entered-in-error Fixed Value: active |
| type | S | 1..1 | CodeableConcept | Category or discipline |
 coding | 1..1 | Coding | Code defined by a terminology system | |
 system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: professional | |
| subType | S | 1..1 | CodeableConcept | More granular claim type |
| coding | 1..1 | Coding | Code defined by a terminology system | |
| system | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types | |
| code | 1..1 | code | Symbol in syntax defined by the system | |
| use | S | 1..1 | code | claim | preauthorization | predetermination Fixed Value: preauthorization |
 patient | S | 1..1 | Reference(Patient core BE profile) | The recipient of the products and services |
| billablePeriod | S | 0..1 | Period | Relevant time frame for the claim |
| created | S | 1..1 | dateTime | Resource creation date |
| enterer | S | 1..1 | Reference(Practitioner role core BE profile) | Author of the claim |
| reference | 1..1 | string | Literal reference, Relative, internal or absolute URL | |
| provider | S | 1..1 | Reference(Organisation core BE profile | Practitioner role core BE profile) | Party responsible for the claim |
| reference | 1..1 | string | Literal reference, Relative, internal or absolute URL | |
| priority | S | 1..1 | CodeableConcept | Desired processing ugency |
| coding | 1..1 | Coding | Code defined by a terminology system | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: stat | |
| referral | S | 0..1 | Reference(ServiceRequest) | Treatment referral |
| reference | 1..1 | string | Literal reference, Relative, internal or absolute URL | |
| supportingInfo | S | 0..* | BackboneElement | Supporting information |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information |
| coding | 1..1 | Coding | Code defined by a terminology system | |
| system | 1..1 | uri | Identity of the terminology system | |
| code | 1..1 | code | Symbol in syntax defined by the system | |
| code | ||||
| coding | 1..1 | Coding | Code defined by a terminology system | |
| system | 1..1 | uri | Identity of the terminology system | |
| code | 1..1 | code | Symbol in syntax defined by the system | |
| insurance | S | 1..1 | BackboneElement | Patient insurance information |
| sequence | 1..1 | positiveInt | Insurance instance identifier Fixed Value: 1 | |
| focal | 1..1 | boolean | Coverage to be used for adjudication Fixed Value: true | |
| coverage | ||||
| display | 1..1 | string | Text alternative for the resource | |
| item | S | 0..* | BackboneElement | Product or service provided |
| productOrService | ||||
| coding | 1..1 | Coding | Code defined by a terminology system Binding: ValueSet product or service (extensible) | |
| system | 1..1 | uri | Identity of the terminology system | |
| code | 1..1 | code | Symbol in syntax defined by the system | |
 serviced[x] | 0..1 | date | Date or dates of service or product delivery | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| Claim.item.productOrService.coding | extensible | BeProductOrServiceNihdiEAgreement (a valid code from CodeSystem NIHDIPhysiotherapyPathology) |
| Id | Grade | Path(s) | Details | Requirements |
| be-rule-eagreementclaim-1 | error | Claim | Billable period start and end SHALL be YYYY-MM-DD : (Claim.billablePeriod.start.exists() implies Claim.billablePeriod.start.toString().length()=10) and (Claim.billablePeriod.end.exists() implies Claim.billablePeriod.end.toString().length()=10) | |
| be-rule-eagreementclaim-2 | error | Claim | Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz : Claim.created.toString().length()=25 |
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization be-rule-eagreementclaim-1: Billable period start and end SHALL be YYYY-MM-DD be-rule-eagreementclaim-2: Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz |
| id | SΣ | 1..1 | id | Logical id of this artifact |
 meta | SΣ | 1..1 | Meta | Metadata about the resource |
| profile | Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active |
| type | SΣ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. |
| coding | Σ | 1..1 | Coding | Code defined by a terminology system |
| system | Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type |
| code | Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: professional |
| subType | S | 1..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. |
| coding | Σ | 1..1 | Coding | Code defined by a terminology system |
| system | Σ | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types |
| code | Σ | 1..1 | code | Symbol in syntax defined by the system |
| use | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Fixed Value: preauthorization |
| patient | SΣ | 1..1 | Reference(Patient core BE profile) | The recipient of the products and services |
| billablePeriod | SΣ | 0..1 | Period | Relevant time frame for the claim |
| created | SΣ | 1..1 | dateTime | Resource creation date |
| enterer | S | 1..1 | Reference(Practitioner role core BE profile) | Author of the claim |
| reference | ΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL |
| provider | SΣ | 1..1 | Reference(Organisation core BE profile | Practitioner role core BE profile) | Party responsible for the claim |
| reference | ΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL |
| priority | SΣ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. |
| coding | Σ | 1..1 | Coding | Code defined by a terminology system |
| system | Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority |
| code | Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: stat |
| referral | S | 0..1 | Reference(ServiceRequest) | Treatment referral |
| reference | ΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL |
| supportingInfo | S | 0..* | BackboneElement | Supporting information |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Information instance identifier | |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. |
| coding | Σ | 1..1 | Coding | Code defined by a terminology system |
| system | Σ | 1..1 | uri | Identity of the terminology system |
| code | Σ | 1..1 | code | Symbol in syntax defined by the system |
| insurance | SΣ | 1..1 | BackboneElement | Patient insurance information |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | Σ | 1..1 | positiveInt | Insurance instance identifier Fixed Value: 1 |
| focal | Σ | 1..1 | boolean | Coverage to be used for adjudication Fixed Value: true |
| coverage | Σ | 1..1 | Reference(Coverage) | Insurance information |
| display | Σ | 1..1 | string | Text alternative for the resource |
| item | S | 0..* | BackboneElement | Product or service provided |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Item instance identifier | |
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |
| coding | Σ | 1..1 | Coding | Code defined by a terminology system Binding: ValueSet product or service (extensible) |
| system | Σ | 1..1 | uri | Identity of the terminology system |
| code | Σ | 1..1 | code | Symbol in syntax defined by the system |
| serviced[x] | 0..1 | date | Date or dates of service or product delivery | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet / Code |
| Claim.status | required | Fixed Value: active |
| Claim.type | extensible | ClaimTypeCodes |
| Claim.subType | example | ExampleClaimSubTypeCodes |
| Claim.use | required | Fixed Value: preauthorization |
| Claim.priority | example | ProcessPriorityCodes |
| Claim.supportingInfo.category | example | ClaimInformationCategoryCodes |
| Claim.item.productOrService | example | USCLSCodes |
| Claim.item.productOrService.coding | extensible | BeProductOrServiceNihdiEAgreement (a valid code from CodeSystem NIHDIPhysiotherapyPathology) |
| Id | Grade | Path(s) | Details | Requirements |
| be-rule-eagreementclaim-1 | error | Claim | Billable period start and end SHALL be YYYY-MM-DD : (Claim.billablePeriod.start.exists() implies Claim.billablePeriod.start.toString().length()=10) and (Claim.billablePeriod.end.exists() implies Claim.billablePeriod.end.toString().length()=10) | |
| be-rule-eagreementclaim-2 | error | Claim | Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz : Claim.created.toString().length()=25 | |
| dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | Claim | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization be-rule-eagreementclaim-1: Billable period start and end SHALL be YYYY-MM-DD be-rule-eagreementclaim-2: Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz | ||||
| id | SΣ | 1..1 | id | Logical id of this artifact | ||||
| meta | SΣ | 1..1 | Meta | Metadata about the resource | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
 extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| versionId | Σ | 0..1 | id | Version specific identifier | ||||
| lastUpdated | Σ | 0..1 | instant | When the resource version last changed | ||||
| source | Σ | 0..1 | uri | Identifies where the resource comes from | ||||
| profile | Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
| security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
| tag | Σ | 0..* | 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". | ||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained | 0..* | Resource | Contained, inline Resources | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier | 0..* | Identifier | Business Identifier for claim | |||||
| status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active | ||||
| type | SΣ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 1..1 | Coding | Code defined by a terminology system | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type | ||||
| version | Σ | 0..1 | string | Version of the system - if relevant | ||||
| code | Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: professional | ||||
| display | Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
| subType | S | 1..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 1..1 | Coding | Code defined by a terminology system | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | Σ | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types | ||||
| version | Σ | 0..1 | string | Version of the system - if relevant | ||||
| code | Σ | 1..1 | code | Symbol in syntax defined by the system | ||||
| display | Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
| use | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Fixed Value: preauthorization | ||||
| patient | SΣ | 1..1 | Reference(Patient core BE profile) | The recipient of the products and services | ||||
| billablePeriod | SΣ | 0..1 | Period | Relevant time frame for the claim | ||||
| created | SΣ | 1..1 | dateTime | Resource creation date | ||||
| enterer | S | 1..1 | Reference(Practitioner role core BE profile) | Author of the claim | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| reference | ΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type | Σ | 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). | ||||
| identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display | Σ | 0..1 | string | Text alternative for the resource | ||||
| insurer | Σ | 0..1 | Reference(Organization) | Target | ||||
| provider | SΣ | 1..1 | Reference(Organisation core BE profile | Practitioner role core BE profile) | Party responsible for the claim | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| reference | ΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type | Σ | 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). | ||||
| identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display | Σ | 0..1 | string | Text alternative for the resource | ||||
| priority | SΣ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 1..1 | Coding | Code defined by a terminology system | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority | ||||
| version | Σ | 0..1 | string | Version of the system - if relevant | ||||
| code | Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: stat | ||||
| display | Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
| fundsReserve | 0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
| related | 0..* | BackboneElement | Prior or corollary claims | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| claim | 0..1 | Reference(Claim) | Reference to the related claim | |||||
| relationship | 0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim. | |||||
| reference | 0..1 | Identifier | File or case reference | |||||
| prescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products | |||||
| originalPrescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller | |||||
| payee | 0..1 | BackboneElement | Recipient of benefits payable | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |||||
| party | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference | |||||
| referral | S | 0..1 | Reference(ServiceRequest) | Treatment referral | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| reference | ΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type | Σ | 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). | ||||
| identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display | Σ | 0..1 | string | Text alternative for the resource | ||||
| facility | 0..1 | Reference(Location) | Servicing facility | |||||
| careTeam | 0..* | BackboneElement | Members of the care team | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence | 1..1 | positiveInt | Order of care team | |||||
| provider | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |||||
| responsible | 0..1 | boolean | Indicator of the lead practitioner | |||||
| role | 0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. | |||||
| qualification | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications. | |||||
| supportingInfo | S | 0..* | BackboneElement | Supporting information | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence | 1..1 | positiveInt | Information instance identifier | |||||
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 1..1 | Coding | Code defined by a terminology system | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | Σ | 1..1 | uri | Identity of the terminology system | ||||
| version | Σ | 0..1 | string | Version of the system - if relevant | ||||
| code | Σ | 1..1 | code | Symbol in syntax defined by the system | ||||
| display | Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 1..1 | Coding | Code defined by a terminology system | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | Σ | 1..1 | uri | Identity of the terminology system | ||||
| version | Σ | 0..1 | string | Version of the system - if relevant | ||||
| code | Σ | 1..1 | code | Symbol in syntax defined by the system | ||||
| display | Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
 timing[x] | 0..1 | When it occurred | ||||||
| timingDate | date | |||||||
| timingPeriod | Period | |||||||
| value[x] | 0..1 | Data to be provided | ||||||
| valueBoolean | boolean | |||||||
| valueString | string | |||||||
| valueQuantity | Quantity | |||||||
| valueAttachment | Attachment | |||||||
| valueReference | Reference(Resource) | |||||||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
| diagnosis | 0..* | BackboneElement | Pertinent diagnosis information | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence | 1..1 | positiveInt | Diagnosis instance identifier | |||||
| diagnosis[x] | 1..1 | Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes. | ||||||
| diagnosisCodeableConcept | CodeableConcept | |||||||
| diagnosisReference | Reference(Condition) | |||||||
| type | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge. | |||||
| onAdmission | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission. | |||||
| packageCode | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis. | |||||
| procedure | 0..* | BackboneElement | Clinical procedures performed | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence | 1..1 | positiveInt | Procedure instance identifier | |||||
| type | 0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes. | |||||
| date | 0..1 | dateTime | When the procedure was performed | |||||
| procedure[x] | 1..1 | Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes. | ||||||
| procedureCodeableConcept | CodeableConcept | |||||||
| procedureReference | Reference(Procedure) | |||||||
| udi | 0..* | Reference(Device) | Unique device identifier | |||||
| insurance | SΣ | 1..1 | BackboneElement | Patient insurance information | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence | Σ | 1..1 | positiveInt | Insurance instance identifier Fixed Value: 1 | ||||
| focal | Σ | 1..1 | boolean | Coverage to be used for adjudication Fixed Value: true | ||||
| identifier | 0..1 | Identifier | Pre-assigned Claim number | |||||
| coverage | Σ | 1..1 | Reference(Coverage) | Insurance information | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| reference | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type | Σ | 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). | ||||
| identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display | Σ | 1..1 | string | Text alternative for the resource | ||||
| businessArrangement | 0..1 | string | Additional provider contract number | |||||
| preAuthRef | 0..* | string | Prior authorization reference number | |||||
| claimResponse | 0..1 | Reference(ClaimResponse) | Adjudication results | |||||
| accident | 0..1 | BackboneElement | Details of the event | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| date | 1..1 | date | When the incident occurred | |||||
| type | 0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc. | |||||
| location[x] | 0..1 | Where the event occurred | ||||||
| locationAddress | Address | |||||||
| locationReference | Reference(Location) | |||||||
| item | S | 0..* | BackboneElement | Product or service provided | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence | 1..1 | positiveInt | Item instance identifier | |||||
| careTeamSequence | 0..* | positiveInt | Applicable careTeam members | |||||
| diagnosisSequence | 0..* | positiveInt | Applicable diagnoses | |||||
| procedureSequence | 0..* | positiveInt | Applicable procedures | |||||
| informationSequence | 0..* | positiveInt | Applicable exception and supporting information | |||||
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 1..1 | Coding | Code defined by a terminology system Binding: ValueSet product or service (extensible) | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | Σ | 1..1 | uri | Identity of the terminology system | ||||
| version | Σ | 0..1 | string | Version of the system - if relevant | ||||
| code | Σ | 1..1 | code | Symbol in syntax defined by the system | ||||
| display | Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
| modifier | 0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
| serviced[x] | 0..1 | date | Date or dates of service or product delivery | |||||
| location[x] | 0..1 | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc. | ||||||
| locationCodeableConcept | CodeableConcept | |||||||
| locationAddress | Address | |||||||
| locationReference | Reference(Location) | |||||||
| quantity | 0..1 | SimpleQuantity | Count of products or services | |||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | |||||
| factor | 0..1 | decimal | Price scaling factor | |||||
| net | 0..1 | Money | Total item cost | |||||
| udi | 0..* | Reference(Device) | Unique device identifier | |||||
| bodySite | 0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch. | |||||
| subSite | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. | |||||
| encounter | 0..* | Reference(Encounter) | Encounters related to this billed item | |||||
| detail | 0..* | BackboneElement | Product or service provided | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence | 1..1 | positiveInt | Item instance identifier | |||||
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
| quantity | 0..1 | SimpleQuantity | Count of products or services | |||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | |||||
| factor | 0..1 | decimal | Price scaling factor | |||||
| net | 0..1 | Money | Total item cost | |||||
| udi | 0..* | Reference(Device) | Unique device identifier | |||||
| subDetail | 0..* | BackboneElement | Product or service provided | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence | 1..1 | positiveInt | Item instance identifier | |||||
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
| quantity | 0..1 | SimpleQuantity | Count of products or services | |||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | |||||
| factor | 0..1 | decimal | Price scaling factor | |||||
| net | 0..1 | Money | Total item cost | |||||
| udi | 0..* | Reference(Device) | Unique device identifier | |||||
| total | 0..1 | Money | Total claim cost | |||||
| Documentation for this format | ||||||||
| Id | Grade | Path(s) | Details | Requirements |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from Claim
Summary
Mandatory: 17 elements (10 nested mandatory elements)
Must-Support: 17 elements
Fixed Value: 8 elements
Structures
This structure refers to these other structures:
Differential View
This structure is derived from Claim
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization be-rule-eagreementclaim-1: Billable period start and end SHALL be YYYY-MM-DD be-rule-eagreementclaim-2: Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz |
| id | S | 1..1 | id | Logical id of this artifact |
| meta | S | 1..1 | Meta | Metadata about the resource |
| profile | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | |
| status | S | 1..1 | code | active | cancelled | draft | entered-in-error Fixed Value: active |
| type | S | 1..1 | CodeableConcept | Category or discipline |
| coding | 1..1 | Coding | Code defined by a terminology system | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: professional | |
| subType | S | 1..1 | CodeableConcept | More granular claim type |
| coding | 1..1 | Coding | Code defined by a terminology system | |
| system | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types | |
| code | 1..1 | code | Symbol in syntax defined by the system | |
| use | S | 1..1 | code | claim | preauthorization | predetermination Fixed Value: preauthorization |
| patient | S | 1..1 | Reference(Patient core BE profile) | The recipient of the products and services |
| billablePeriod | S | 0..1 | Period | Relevant time frame for the claim |
| created | S | 1..1 | dateTime | Resource creation date |
| enterer | S | 1..1 | Reference(Practitioner role core BE profile) | Author of the claim |
| reference | 1..1 | string | Literal reference, Relative, internal or absolute URL | |
| provider | S | 1..1 | Reference(Organisation core BE profile | Practitioner role core BE profile) | Party responsible for the claim |
| reference | 1..1 | string | Literal reference, Relative, internal or absolute URL | |
| priority | S | 1..1 | CodeableConcept | Desired processing ugency |
| coding | 1..1 | Coding | Code defined by a terminology system | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: stat | |
| referral | S | 0..1 | Reference(ServiceRequest) | Treatment referral |
| reference | 1..1 | string | Literal reference, Relative, internal or absolute URL | |
| supportingInfo | S | 0..* | BackboneElement | Supporting information |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information |
| coding | 1..1 | Coding | Code defined by a terminology system | |
| system | 1..1 | uri | Identity of the terminology system | |
| code | 1..1 | code | Symbol in syntax defined by the system | |
| code | ||||
| coding | 1..1 | Coding | Code defined by a terminology system | |
| system | 1..1 | uri | Identity of the terminology system | |
| code | 1..1 | code | Symbol in syntax defined by the system | |
| insurance | S | 1..1 | BackboneElement | Patient insurance information |
| sequence | 1..1 | positiveInt | Insurance instance identifier Fixed Value: 1 | |
| focal | 1..1 | boolean | Coverage to be used for adjudication Fixed Value: true | |
| coverage | ||||
| display | 1..1 | string | Text alternative for the resource | |
| item | S | 0..* | BackboneElement | Product or service provided |
| productOrService | ||||
| coding | 1..1 | Coding | Code defined by a terminology system Binding: ValueSet product or service (extensible) | |
| system | 1..1 | uri | Identity of the terminology system | |
| code | 1..1 | code | Symbol in syntax defined by the system | |
| serviced[x] | 0..1 | date | Date or dates of service or product delivery | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| Claim.item.productOrService.coding | extensible | BeProductOrServiceNihdiEAgreement (a valid code from CodeSystem NIHDIPhysiotherapyPathology) |
| Id | Grade | Path(s) | Details | Requirements |
| be-rule-eagreementclaim-1 | error | Claim | Billable period start and end SHALL be YYYY-MM-DD : (Claim.billablePeriod.start.exists() implies Claim.billablePeriod.start.toString().length()=10) and (Claim.billablePeriod.end.exists() implies Claim.billablePeriod.end.toString().length()=10) | |
| be-rule-eagreementclaim-2 | error | Claim | Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz : Claim.created.toString().length()=25 |
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization be-rule-eagreementclaim-1: Billable period start and end SHALL be YYYY-MM-DD be-rule-eagreementclaim-2: Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz |
| id | SΣ | 1..1 | id | Logical id of this artifact |
| meta | SΣ | 1..1 | Meta | Metadata about the resource |
| profile | Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active |
| type | SΣ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. |
| coding | Σ | 1..1 | Coding | Code defined by a terminology system |
| system | Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type |
| code | Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: professional |
| subType | S | 1..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. |
| coding | Σ | 1..1 | Coding | Code defined by a terminology system |
| system | Σ | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types |
| code | Σ | 1..1 | code | Symbol in syntax defined by the system |
| use | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Fixed Value: preauthorization |
| patient | SΣ | 1..1 | Reference(Patient core BE profile) | The recipient of the products and services |
| billablePeriod | SΣ | 0..1 | Period | Relevant time frame for the claim |
| created | SΣ | 1..1 | dateTime | Resource creation date |
| enterer | S | 1..1 | Reference(Practitioner role core BE profile) | Author of the claim |
| reference | ΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL |
| provider | SΣ | 1..1 | Reference(Organisation core BE profile | Practitioner role core BE profile) | Party responsible for the claim |
| reference | ΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL |
| priority | SΣ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. |
| coding | Σ | 1..1 | Coding | Code defined by a terminology system |
| system | Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority |
| code | Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: stat |
| referral | S | 0..1 | Reference(ServiceRequest) | Treatment referral |
| reference | ΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL |
| supportingInfo | S | 0..* | BackboneElement | Supporting information |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Information instance identifier | |
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. |
| coding | Σ | 1..1 | Coding | Code defined by a terminology system |
| system | Σ | 1..1 | uri | Identity of the terminology system |
| code | Σ | 1..1 | code | Symbol in syntax defined by the system |
| insurance | SΣ | 1..1 | BackboneElement | Patient insurance information |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | Σ | 1..1 | positiveInt | Insurance instance identifier Fixed Value: 1 |
| focal | Σ | 1..1 | boolean | Coverage to be used for adjudication Fixed Value: true |
| coverage | Σ | 1..1 | Reference(Coverage) | Insurance information |
| display | Σ | 1..1 | string | Text alternative for the resource |
| item | S | 0..* | BackboneElement | Product or service provided |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| sequence | 1..1 | positiveInt | Item instance identifier | |
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |
| coding | Σ | 1..1 | Coding | Code defined by a terminology system Binding: ValueSet product or service (extensible) |
| system | Σ | 1..1 | uri | Identity of the terminology system |
| code | Σ | 1..1 | code | Symbol in syntax defined by the system |
| serviced[x] | 0..1 | date | Date or dates of service or product delivery | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet / Code |
| Claim.status | required | Fixed Value: active |
| Claim.type | extensible | ClaimTypeCodes |
| Claim.subType | example | ExampleClaimSubTypeCodes |
| Claim.use | required | Fixed Value: preauthorization |
| Claim.priority | example | ProcessPriorityCodes |
| Claim.supportingInfo.category | example | ClaimInformationCategoryCodes |
| Claim.item.productOrService | example | USCLSCodes |
| Claim.item.productOrService.coding | extensible | BeProductOrServiceNihdiEAgreement (a valid code from CodeSystem NIHDIPhysiotherapyPathology) |
| Id | Grade | Path(s) | Details | Requirements |
| be-rule-eagreementclaim-1 | error | Claim | Billable period start and end SHALL be YYYY-MM-DD : (Claim.billablePeriod.start.exists() implies Claim.billablePeriod.start.toString().length()=10) and (Claim.billablePeriod.end.exists() implies Claim.billablePeriod.end.toString().length()=10) | |
| be-rule-eagreementclaim-2 | error | Claim | Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz : Claim.created.toString().length()=25 | |
| dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | Claim | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization be-rule-eagreementclaim-1: Billable period start and end SHALL be YYYY-MM-DD be-rule-eagreementclaim-2: Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz | ||||
| id | SΣ | 1..1 | id | Logical id of this artifact | ||||
| meta | SΣ | 1..1 | Meta | Metadata about the resource | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| versionId | Σ | 0..1 | id | Version specific identifier | ||||
| lastUpdated | Σ | 0..1 | instant | When the resource version last changed | ||||
| source | Σ | 0..1 | uri | Identifies where the resource comes from | ||||
| profile | Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
| security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
| tag | Σ | 0..* | 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". | ||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained | 0..* | Resource | Contained, inline Resources | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier | 0..* | Identifier | Business Identifier for claim | |||||
| status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active | ||||
| type | SΣ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 1..1 | Coding | Code defined by a terminology system | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type | ||||
| version | Σ | 0..1 | string | Version of the system - if relevant | ||||
| code | Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: professional | ||||
| display | Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
| subType | S | 1..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 1..1 | Coding | Code defined by a terminology system | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | Σ | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types | ||||
| version | Σ | 0..1 | string | Version of the system - if relevant | ||||
| code | Σ | 1..1 | code | Symbol in syntax defined by the system | ||||
| display | Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
| use | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Fixed Value: preauthorization | ||||
| patient | SΣ | 1..1 | Reference(Patient core BE profile) | The recipient of the products and services | ||||
| billablePeriod | SΣ | 0..1 | Period | Relevant time frame for the claim | ||||
| created | SΣ | 1..1 | dateTime | Resource creation date | ||||
| enterer | S | 1..1 | Reference(Practitioner role core BE profile) | Author of the claim | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| reference | ΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type | Σ | 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). | ||||
| identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display | Σ | 0..1 | string | Text alternative for the resource | ||||
| insurer | Σ | 0..1 | Reference(Organization) | Target | ||||
| provider | SΣ | 1..1 | Reference(Organisation core BE profile | Practitioner role core BE profile) | Party responsible for the claim | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| reference | ΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type | Σ | 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). | ||||
| identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display | Σ | 0..1 | string | Text alternative for the resource | ||||
| priority | SΣ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred. | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 1..1 | Coding | Code defined by a terminology system | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | Σ | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority | ||||
| version | Σ | 0..1 | string | Version of the system - if relevant | ||||
| code | Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: stat | ||||
| display | Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
| fundsReserve | 0..1 | CodeableConcept | For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
| related | 0..* | BackboneElement | Prior or corollary claims | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| claim | 0..1 | Reference(Claim) | Reference to the related claim | |||||
| relationship | 0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim. | |||||
| reference | 0..1 | Identifier | File or case reference | |||||
| prescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Prescription authorizing services and products | |||||
| originalPrescription | 0..1 | Reference(DeviceRequest | MedicationRequest | VisionPrescription) | Original prescription if superseded by fulfiller | |||||
| payee | 0..1 | BackboneElement | Recipient of benefits payable | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |||||
| party | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference | |||||
| referral | S | 0..1 | Reference(ServiceRequest) | Treatment referral | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| reference | ΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type | Σ | 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). | ||||
| identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display | Σ | 0..1 | string | Text alternative for the resource | ||||
| facility | 0..1 | Reference(Location) | Servicing facility | |||||
| careTeam | 0..* | BackboneElement | Members of the care team | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence | 1..1 | positiveInt | Order of care team | |||||
| provider | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Practitioner or organization | |||||
| responsible | 0..1 | boolean | Indicator of the lead practitioner | |||||
| role | 0..1 | CodeableConcept | Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members. | |||||
| qualification | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications. | |||||
| supportingInfo | S | 0..* | BackboneElement | Supporting information | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence | 1..1 | positiveInt | Information instance identifier | |||||
| category | S | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 1..1 | Coding | Code defined by a terminology system | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | Σ | 1..1 | uri | Identity of the terminology system | ||||
| version | Σ | 0..1 | string | Version of the system - if relevant | ||||
| code | Σ | 1..1 | code | Symbol in syntax defined by the system | ||||
| display | Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
| code | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes. | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 1..1 | Coding | Code defined by a terminology system | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | Σ | 1..1 | uri | Identity of the terminology system | ||||
| version | Σ | 0..1 | string | Version of the system - if relevant | ||||
| code | Σ | 1..1 | code | Symbol in syntax defined by the system | ||||
| display | Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
| timing[x] | 0..1 | When it occurred | ||||||
| timingDate | date | |||||||
| timingPeriod | Period | |||||||
| value[x] | 0..1 | Data to be provided | ||||||
| valueBoolean | boolean | |||||||
| valueString | string | |||||||
| valueQuantity | Quantity | |||||||
| valueAttachment | Attachment | |||||||
| valueReference | Reference(Resource) | |||||||
| reason | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth. | |||||
| diagnosis | 0..* | BackboneElement | Pertinent diagnosis information | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence | 1..1 | positiveInt | Diagnosis instance identifier | |||||
| diagnosis[x] | 1..1 | Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes. | ||||||
| diagnosisCodeableConcept | CodeableConcept | |||||||
| diagnosisReference | Reference(Condition) | |||||||
| type | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge. | |||||
| onAdmission | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission. | |||||
| packageCode | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis. | |||||
| procedure | 0..* | BackboneElement | Clinical procedures performed | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence | 1..1 | positiveInt | Procedure instance identifier | |||||
| type | 0..* | CodeableConcept | Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes. | |||||
| date | 0..1 | dateTime | When the procedure was performed | |||||
| procedure[x] | 1..1 | Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes. | ||||||
| procedureCodeableConcept | CodeableConcept | |||||||
| procedureReference | Reference(Procedure) | |||||||
| udi | 0..* | Reference(Device) | Unique device identifier | |||||
| insurance | SΣ | 1..1 | BackboneElement | Patient insurance information | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence | Σ | 1..1 | positiveInt | Insurance instance identifier Fixed Value: 1 | ||||
| focal | Σ | 1..1 | boolean | Coverage to be used for adjudication Fixed Value: true | ||||
| identifier | 0..1 | Identifier | Pre-assigned Claim number | |||||
| coverage | Σ | 1..1 | Reference(Coverage) | Insurance information | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| reference | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type | Σ | 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). | ||||
| identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display | Σ | 1..1 | string | Text alternative for the resource | ||||
| businessArrangement | 0..1 | string | Additional provider contract number | |||||
| preAuthRef | 0..* | string | Prior authorization reference number | |||||
| claimResponse | 0..1 | Reference(ClaimResponse) | Adjudication results | |||||
| accident | 0..1 | BackboneElement | Details of the event | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| date | 1..1 | date | When the incident occurred | |||||
| type | 0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc. | |||||
| location[x] | 0..1 | Where the event occurred | ||||||
| locationAddress | Address | |||||||
| locationReference | Reference(Location) | |||||||
| item | S | 0..* | BackboneElement | Product or service provided | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence | 1..1 | positiveInt | Item instance identifier | |||||
| careTeamSequence | 0..* | positiveInt | Applicable careTeam members | |||||
| diagnosisSequence | 0..* | positiveInt | Applicable diagnoses | |||||
| procedureSequence | 0..* | positiveInt | Applicable procedures | |||||
| informationSequence | 0..* | positiveInt | Applicable exception and supporting information | |||||
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding | Σ | 1..1 | Coding | Code defined by a terminology system Binding: ValueSet product or service (extensible) | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | Σ | 1..1 | uri | Identity of the terminology system | ||||
| version | Σ | 0..1 | string | Version of the system - if relevant | ||||
| code | Σ | 1..1 | code | Symbol in syntax defined by the system | ||||
| display | Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| text | Σ | 0..1 | string | Plain text representation of the concept | ||||
| modifier | 0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
| serviced[x] | 0..1 | date | Date or dates of service or product delivery | |||||
| location[x] | 0..1 | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc. | ||||||
| locationCodeableConcept | CodeableConcept | |||||||
| locationAddress | Address | |||||||
| locationReference | Reference(Location) | |||||||
| quantity | 0..1 | SimpleQuantity | Count of products or services | |||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | |||||
| factor | 0..1 | decimal | Price scaling factor | |||||
| net | 0..1 | Money | Total item cost | |||||
| udi | 0..* | Reference(Device) | Unique device identifier | |||||
| bodySite | 0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch. | |||||
| subSite | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. | |||||
| encounter | 0..* | Reference(Encounter) | Encounters related to this billed item | |||||
| detail | 0..* | BackboneElement | Product or service provided | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence | 1..1 | positiveInt | Item instance identifier | |||||
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
| quantity | 0..1 | SimpleQuantity | Count of products or services | |||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | |||||
| factor | 0..1 | decimal | Price scaling factor | |||||
| net | 0..1 | Money | Total item cost | |||||
| udi | 0..* | Reference(Device) | Unique device identifier | |||||
| subDetail | 0..* | BackboneElement | Product or service provided | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| sequence | 1..1 | positiveInt | Item instance identifier | |||||
| revenue | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses. | |||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
| quantity | 0..1 | SimpleQuantity | Count of products or services | |||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | |||||
| factor | 0..1 | decimal | Price scaling factor | |||||
| net | 0..1 | Money | Total item cost | |||||
| udi | 0..* | Reference(Device) | Unique device identifier | |||||
| total | 0..1 | Money | Total claim cost | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet / Code | ||||
| Claim.meta.security | extensible | All Security Labels | ||||
| Claim.meta.tag | example | CommonTags | ||||
| Claim.language | preferred | CommonLanguages
| ||||
| Claim.status | required | Fixed Value: active | ||||
| Claim.type | extensible | ClaimTypeCodes | ||||
| Claim.subType | example | ExampleClaimSubTypeCodes | ||||
| Claim.use | required | Fixed Value: preauthorization | ||||
| Claim.enterer.type | extensible | ResourceType | ||||
| Claim.provider.type | extensible | ResourceType | ||||
| Claim.priority | example | ProcessPriorityCodes | ||||
| Claim.fundsReserve | example | Funds Reservation Codes | ||||
| Claim.related.relationship | example | ExampleRelatedClaimRelationshipCodes | ||||
| Claim.payee.type | example | Claim Payee Type Codes | ||||
| Claim.referral.type | extensible | ResourceType | ||||
| Claim.careTeam.role | example | ClaimCareTeamRoleCodes | ||||
| Claim.careTeam.qualification | example | ExampleProviderQualificationCodes | ||||
| Claim.supportingInfo.category | example | ClaimInformationCategoryCodes | ||||
| Claim.supportingInfo.code | example | ExceptionCodes | ||||
| Claim.supportingInfo.reason | example | MissingToothReasonCodes | ||||
| Claim.diagnosis.diagnosis[x] | example | ICD-10Codes | ||||
| Claim.diagnosis.type | example | ExampleDiagnosisTypeCodes | ||||
| Claim.diagnosis.onAdmission | example | ExampleDiagnosisOnAdmissionCodes | ||||
| Claim.diagnosis.packageCode | example | ExampleDiagnosisRelatedGroupCodes | ||||
| Claim.procedure.type | example | ExampleProcedureTypeCodes | ||||
| Claim.procedure.procedure[x] | example | ICD-10ProcedureCodes | ||||
| Claim.insurance.coverage.type | extensible | ResourceType | ||||
| Claim.accident.type | extensible | ActIncidentCode | ||||
| Claim.item.revenue | example | ExampleRevenueCenterCodes | ||||
| Claim.item.category | example | BenefitCategoryCodes | ||||
| Claim.item.productOrService | example | USCLSCodes | ||||
| Claim.item.productOrService.coding | extensible | BeProductOrServiceNihdiEAgreement (a valid code from CodeSystem NIHDIPhysiotherapyPathology) | ||||
| Claim.item.modifier | example | ModifierTypeCodes | ||||
| Claim.item.programCode | example | ExampleProgramReasonCodes | ||||
| Claim.item.location[x] | example | ExampleServicePlaceCodes | ||||
| Claim.item.bodySite | example | OralSiteCodes | ||||
| Claim.item.subSite | example | SurfaceCodes | ||||
| Claim.item.detail.revenue | example | ExampleRevenueCenterCodes | ||||
| Claim.item.detail.category | example | BenefitCategoryCodes | ||||
| Claim.item.detail.productOrService | example | USCLSCodes | ||||
| Claim.item.detail.modifier | example | ModifierTypeCodes | ||||
| Claim.item.detail.programCode | example | ExampleProgramReasonCodes | ||||
| Claim.item.detail.subDetail.revenue | example | ExampleRevenueCenterCodes | ||||
| Claim.item.detail.subDetail.category | example | BenefitCategoryCodes | ||||
| Claim.item.detail.subDetail.productOrService | example | USCLSCodes | ||||
| Claim.item.detail.subDetail.modifier | example | ModifierTypeCodes | ||||
| Claim.item.detail.subDetail.programCode | example | ExampleProgramReasonCodes |
| Id | Grade | Path(s) | Details | Requirements |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from Claim
Summary
Mandatory: 17 elements (10 nested mandatory elements)
Must-Support: 17 elements
Fixed Value: 8 elements
Structures
This structure refers to these other structures:
Other representations of profile: CSV, Excel, Schematron
IG © 2022+ eHealth Platform. Package hl7.fhir.be.mycarenet#2.0.0 based on FHIR 4.0.1. Generated 2023-04-27
Links: Table of Contents |
QA Report
