Claim (9)

#NameSourceVerDescription
1Claim_eltsshl7.fhir.us.eltss#currentR4Claim Resource profile for eLTSS
2PAS Claimhl7.fhir.us.davinci-pas#currentR4PAS constraints on Claim resource mandating support for elements relevant to the prior authorization request
3PAS Claim Basehl7.fhir.us.davinci-pas#currentR4PAS constraints on Claim resource that are common to both the request and the inquiry.
4PAS Claim Inquiryhl7.fhir.us.davinci-pas#currentR4PAS constraints on Claim resource when submitting an inquiry for existing authorizations.
5PAS Claim Updatehl7.fhir.us.davinci-pas#currentR4PAS constraints on Claim resource when submitting an update to a previous PAS prior authorization request
6PCT Good Faith Estimate Institutionalhl7.fhir.us.davinci-pct#currentR4PCT Good Faith Estimate Institutional is a profile for capturing submission data needed to be processed by a payer for the creation of an Advanced EOB. This profile is used for an institutional GFE submission.
7PCT Good Faith Estimate Professionalhl7.fhir.us.davinci-pct#currentR4PCT Good Faith Estimate Professional is a profile for capturing submission data needed to be processed by a payer for the creation of an Advanced EOB. This profile is used for a professional GFE submission.
8QICore Claimhl7.fhir.us.qicore#currentR4Profile of Claim for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.
9RTPBC Request Using Claimhl7.fhir.us.carin-rtpbc#1.0.0R4This profile constrains the Claim resource so that it can serve as the RTPBC Request in the consumer real-time pharmacy benefit check process
1 2 3 4 5 6 7 8 9
Claim D
Claim.id C D
Claim.meta
Claim.implicitRules
Claim.language
Claim.text
Claim.contained
Claim.extension S C (2) S C S C (4) S C S C D (5) S C D (5)
Claim.extension.value[x]
Claim.modifierExtension
Claim.identifier C C S C (3) S C (3) C
Claim.identifier.value C C C D
Claim.identifier.system
Claim.identifier.type C F (2) C F (2)
Claim.traceNumber
Claim.status F F D
Claim.type F F D
Claim.type.coding C
Claim.type.coding.display C F
Claim.type.coding.code C F
Claim.type.coding.system C F
Claim.subType
Claim.use F F F F D
Claim.patient D
Claim.patient.reference C D
Claim.billablePeriod
Claim.created D
Claim.enterer
Claim.insurer C C C
Claim.provider D
Claim.provider.reference C D
Claim.provider.extension S C (3) S C (3)
Claim.priority B M B M D
Claim.priority.coding C
Claim.priority.coding.display C F
Claim.priority.coding.code C F
Claim.priority.coding.system C F
Claim.fundsReserve
Claim.related
Claim.related.extension
Claim.related.modifierExtension
Claim.related.claim
Claim.related.relationship
Claim.related.reference
Claim.prescription C D
Claim.prescription.reference C
Claim.originalPrescription
Claim.payee
Claim.payee.extension
Claim.payee.modifierExtension
Claim.payee.type
Claim.payee.party
Claim.referral
Claim.referral.extension S C (2) S C (2)
Claim.encounter
Claim.facility
Claim.diagnosisRelatedGroup
Claim.event
Claim.event.extension
Claim.event.modifierExtension
Claim.event.type
Claim.event.when[x]
Claim.careTeam S C D (3) S C (5) S C (3) C D
Claim.careTeam.qualification B M (3) C B M (2) C B M (2)
Claim.careTeam.extension S C (6)
Claim.careTeam.extension.value[x] F (2)
Claim.careTeam.modifierExtension
Claim.careTeam.sequence F
Claim.careTeam.provider (4) C D
Claim.careTeam.provider.reference C D
Claim.careTeam.responsible
Claim.careTeam.role B M (3) C F B M (5) C F B M (3)
Claim.careTeam.specialty
Claim.supportingInfo S C (2) S C (4) S C D (6) S C D (3)
Claim.supportingInfo.valueReference C C
Claim.supportingInfo.extension S C (2)
Claim.supportingInfo.modifierExtension S C (2)
Claim.supportingInfo.sequence
Claim.supportingInfo.category F (2) F B M (4) F B M (6) F B M (3)
Claim.supportingInfo.code C B M (4) C B M
Claim.supportingInfo.timing[x] C (2) S C I (9)
Claim.supportingInfo.timing[x].end I (3)
Claim.supportingInfo.timing[x].start I (3)
Claim.supportingInfo.value[x] C D (2) C (3) S C S C
Claim.supportingInfo.reason
Claim.diagnosis D S C (6) S C (3)
Claim.diagnosis.extension S C (2)
Claim.diagnosis.modifierExtension
Claim.diagnosis.sequence F F
Claim.diagnosis.diagnosis[x] S C (2) B M B M (5) B M (2) B M
Claim.diagnosis.type C B M C F B M (6) C F B M (3)
Claim.diagnosis.onAdmission B M
Claim.procedure S C (3) S C (3)
Claim.procedure.extension S C (4) S C (3)
Claim.procedure.modifierExtension
Claim.procedure.sequence F
Claim.procedure.type C F B M (3) C F B M (2)
Claim.procedure.date
Claim.procedure.procedure[x] B M (2) B M B M
Claim.procedure.udi
Claim.insurance C D
Claim.insurance.extension
Claim.insurance.modifierExtension
Claim.insurance.sequence F D
Claim.insurance.focal F F
Claim.insurance.identifier
Claim.insurance.coverage C D
Claim.insurance.coverage.reference C D
Claim.insurance.businessArrangement
Claim.insurance.preAuthRef C C
Claim.insurance.claimResponse
Claim.accident
Claim.accident.extension
Claim.accident.modifierExtension
Claim.accident.date D
Claim.accident.type B M
Claim.accident.location[x] S C (2)
Claim.accident.location[x].country B M B M
Claim.patientPaid
Claim.item D C C C C
Claim.item.locationCodeableConcept C B M C B M
Claim.item.extension S C (5) S C (7) S C (4) S C S C D (4) S C D (5)
Claim.item.extension.value[x] B M
Claim.item.modifierExtension S C (2)
Claim.item.sequence F D
Claim.item.traceNumber
Claim.item.careTeamSequence C D
Claim.item.diagnosisSequence
Claim.item.procedureSequence
Claim.item.informationSequence
Claim.item.revenue B M C B M
Claim.item.category C B M
Claim.item.productOrService B M D B M B M D B M
Claim.item.productOrService.coding C
Claim.item.productOrService.coding.display C D
Claim.item.productOrService.coding.code C
Claim.item.productOrService.coding.system C
Claim.item.productOrServiceEnd
Claim.item.request
Claim.item.modifier B M C B M C B M
Claim.item.programCode
Claim.item.serviced[x] C D C D
Claim.item.location[x] B M S C
Claim.item.patientPaid
Claim.item.quantity D C C C
Claim.item.quantity.unit C D B M
Claim.item.quantity.value C D
Claim.item.unitPrice D C
Claim.item.factor
Claim.item.tax
Claim.item.net D C C
Claim.item.udi
Claim.item.bodySite
Claim.item.bodySite.extension
Claim.item.bodySite.modifierExtension
Claim.item.bodySite.site
Claim.item.bodySite.subSite
Claim.item.encounter
Claim.item.detail
Claim.item.detail.extension
Claim.item.detail.modifierExtension
Claim.item.detail.sequence
Claim.item.detail.traceNumber
Claim.item.detail.revenue
Claim.item.detail.category
Claim.item.detail.productOrService B M B M
Claim.item.detail.productOrServiceEnd
Claim.item.detail.modifier
Claim.item.detail.programCode
Claim.item.detail.patientPaid
Claim.item.detail.quantity
Claim.item.detail.unitPrice
Claim.item.detail.factor
Claim.item.detail.tax
Claim.item.detail.net
Claim.item.detail.udi
Claim.item.detail.subDetail
Claim.item.detail.subDetail.extension
Claim.item.detail.subDetail.modifierExtension
Claim.item.detail.subDetail.sequence
Claim.item.detail.subDetail.traceNumber
Claim.item.detail.subDetail.revenue
Claim.item.detail.subDetail.category
Claim.item.detail.subDetail.productOrService
Claim.item.detail.subDetail.productOrServiceEnd
Claim.item.detail.subDetail.modifier
Claim.item.detail.subDetail.programCode
Claim.item.detail.subDetail.patientPaid
Claim.item.detail.subDetail.quantity
Claim.item.detail.subDetail.unitPrice
Claim.item.detail.subDetail.factor
Claim.item.detail.subDetail.tax
Claim.item.detail.subDetail.net
Claim.item.detail.subDetail.udi
Claim.total C C
S: There is slicing defined in the element(s)
C: There is cardinality erstrictions defined in the element(s)
I: There is invariants defined in the element(s)
F: There is a fixed or pattern value defined in the element(s)
D: There is document provided in the element(s)
B: There is terminology bindings defined in the element(s)
M: At least one of the element(s) has must-support = true
(N): The number of elements if > 1

Produced 08 Sep 2023