EHI Export Implementation Guide
0.1.0 - ci-build
EHI Export Implementation Guide - Local Development build (v0.1.0). See the Directory of published versions
Draft as of 2024-02-05 |
Definitions for the Claim resource profile.
Guidance on how to interpret the contents of this table can be found here
0. Claim | |
Definition | Insurance Claim for the patient |
Short | Claim |
2. Claim.careLevel | |
Definition | Code used for care level |
Short | Code used for care level |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
4. Claim.created | |
Definition | Timestamp when the claim was created |
Short | Timestamp when the claim was created |
Control | 0..1 |
Type | dateTime |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
6. Claim.dailyRate | |
Definition | Amount used for daily rate |
Short | Amount used for daily rate |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
8. Claim.description | |
Definition | Description |
Short | Description |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
10. Claim.fedTaxNumber | |
Definition | Federal tax number |
Short | Federal tax number |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
12. Claim.grandTotal | |
Definition | Total amount for the claim |
Short | Total amount for the claim |
Control | 0..1 |
Type | Money |
14. Claim.hippsCode | |
Definition | Health Insurance Prospective Payment System (HIPPS) Code |
Short | Health Insurance Prospective Payment System (HIPPS) Code |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
16. Claim.identifier | |
Definition | Identification key |
Short | Identification key |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 1..1 |
Type | Identifier |
18. Claim.insuredName | |
Definition | Insure's name - combines Last name, First name, Middle name |
Short | Insure's name - combines Last name, First name, Middle name |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
20. Claim.insuredUniqueId | |
Definition | Insurance policy number |
Short | Insurance policy number |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
22. Claim.nonCoveredCharges | |
Definition | Amount not covered in the claim |
Short | Amount not covered in the claim |
Control | 0..1 |
Type | Money |
24. Claim.npi | |
Definition | NPI Number |
Short | NPI Number |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
26. Claim.payer | |
Definition | Payer name |
Short | Payer name |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
28. Claim.period | |
Definition | The period for which charges are being submitted. |
Short | The period for which charges are being submitted. |
Control | 0..1 |
Type | Extension(Period) (Extension Type: Period) |
Summary | true |
30. Claim.revCO | |
Definition | Revenue Code |
Short | Revenue Code |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
32. Claim.serviceDate | |
Definition | Date of service for the claim |
Short | Date of service for the claim |
Control | 0..1 |
Type | dateTime |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
34. Claim.serviceUnits | |
Definition | Days amount for service units |
Short | Days amount for service units |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
36. Claim.status | |
Definition | Claim's status |
Short | Claim's status |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
38. Claim.subject | |
Definition | Patient subject reference |
Short | Patient subject reference |
Control | 1..1 |
Type | Reference(Patient) |
40. Claim.totalCharges | |
Definition | Transaction amount |
Short | Transaction amount |
Control | 0..1 |
Type | Money |
42. Claim.use | |
Definition | Fixed as: Claim |
Short | Fixed as: Claim |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Guidance on how to interpret the contents of this table can be found here
0. Claim | |
Definition | Insurance Claim for the patient A resource that includes narrative, extensions, and contained resources. |
Short | ClaimA resource with narrative, extensions, and contained resources |
Control | 0..* |
Is Modifier | false |
Summary | false |
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty() )dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label ( contained.meta.security.empty() )dom-6: A resource should have narrative for robust management ( text.`div`.exists() )dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (text.`div`.exists()) |
2. Claim.implicitRules | |
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. |
Short | A set of rules under which this content was created |
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. |
Control | 0..1 |
Type | uri |
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
4. Claim.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them |
Summary | false |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
Slicing | This element introduces a set of slices on Claim.modifierExtension . The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: |
6. Claim.careLevel | |
Definition | Code used for care level |
Short | Code used for care level |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
8. Claim.created | |
Definition | Timestamp when the claim was created The date this resource was created. |
Short | Timestamp when the claim was createdResource creation date |
Comments | This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date. |
Control | 01..1 |
Type | dateTime |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Need to record a timestamp for use by both the recipient and the issuer. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
10. Claim.dailyRate | |
Definition | Amount used for daily rate |
Short | Amount used for daily rate |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
12. Claim.description | |
Definition | Description |
Short | Description |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
14. Claim.fedTaxNumber | |
Definition | Federal tax number |
Short | Federal tax number |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
16. Claim.grandTotal | |
Definition | Total amount for the claim |
Short | Total amount for the claim |
Control | 0..1 |
Type | Money |
Summary | true |
18. Claim.hippsCode | |
Definition | Health Insurance Prospective Payment System (HIPPS) Code |
Short | Health Insurance Prospective Payment System (HIPPS) Code |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
20. Claim.identifier | |
Definition | Identification key A unique identifier assigned to this claim. |
Short | Identification keyBusiness Identifier for claim |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 10..1* |
Type | Identifier |
Is Modifier | false |
Summary | true |
Requirements | Allows claims to be distinguished and referenced. |
Alternate Names | Claim Number |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
22. Claim.insuredName | |
Definition | Insure's name - combines Last name, First name, Middle name |
Short | Insure's name - combines Last name, First name, Middle name |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
24. Claim.insuredUniqueId | |
Definition | Insurance policy number |
Short | Insurance policy number |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
26. Claim.nonCoveredCharges | |
Definition | Amount not covered in the claim |
Short | Amount not covered in the claim |
Control | 0..1 |
Type | Money |
Summary | true |
28. Claim.npi | |
Definition | NPI Number |
Short | NPI Number |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
30. Claim.payer | |
Definition | Payer name |
Short | Payer name |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
32. Claim.period | |
Definition | The period for which charges are being submitted. |
Short | The period for which charges are being submitted. |
Control | 0..1 |
Type | Extension(Period) (Extension Type: Period) |
Summary | true |
34. Claim.revCO | |
Definition | Revenue Code |
Short | Revenue Code |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
36. Claim.serviceDate | |
Definition | Date of service for the claim |
Short | Date of service for the claim |
Control | 0..1 |
Type | dateTime |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
38. Claim.serviceUnits | |
Definition | Days amount for service units |
Short | Days amount for service units |
Control | 0..1 |
Type | string |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
40. Claim.status | |
Definition | Claim's status The status of the resource instance. |
Short | Claim's statusactive | cancelled | draft | entered-in-error |
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. |
Control | 01..1 |
Type | stringcode |
Is Modifier | true because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
42. Claim.subject | |
Definition | Patient subject reference |
Short | Patient subject reference |
Control | 1..1 |
Type | Reference(Patient) |
Summary | true |
44. Claim.totalCharges | |
Definition | Transaction amount |
Short | Transaction amount |
Control | 0..1 |
Type | Money |
Summary | true |
46. Claim.use | |
Definition | Fixed as: Claim A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future. |
Short | Fixed as: Claimclaim | preauthorization | predetermination |
Control | 01..1 |
Type | stringcode |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | This element is required to understand the nature of the request for adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Guidance on how to interpret the contents of this table can be found here
0. Claim | |||||
Definition | Insurance Claim for the patient | ||||
Short | Claim | ||||
Control | 0..* | ||||
Is Modifier | false | ||||
Summary | false | ||||
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty() )dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label ( contained.meta.security.empty() )dom-6: A resource should have narrative for robust management ( text.`div`.exists() ) | ||||
2. Claim.id | |||||
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. | ||||
Short | Logical id of this artifact | ||||
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation. | ||||
Control | 0..1 | ||||
Type | id | ||||
Is Modifier | false | ||||
Summary | true | ||||
4. Claim.meta | |||||
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. | ||||
Short | Metadata about the resource | ||||
Control | 0..1 | ||||
Type | Meta | ||||
Is Modifier | false | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
6. Claim.implicitRules | |||||
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. | ||||
Short | A set of rules under which this content was created | ||||
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. | ||||
Control | 0..1 | ||||
Type | uri | ||||
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
8. Claim.language | |||||
Definition | The base language in which the resource is written. | ||||
Short | Language of the resource content | ||||
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). | ||||
Control | 0..1 | ||||
Binding | The codes SHOULD be taken from CommonLanguages: A human language.
| ||||
Type | code | ||||
Is Modifier | false | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | false | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
10. Claim.text | |||||
Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. | ||||
Short | Text summary of the resource, for human interpretation | ||||
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. | ||||
Control | 0..1 | ||||
Type | Narrative | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | narrative, html, xhtml, display | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) | ||||
12. Claim.contained | |||||
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. | ||||
Short | Contained, inline Resources | ||||
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. | ||||
Control | 0..* | ||||
Type | Resource | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | inline resources, anonymous resources, contained resources | ||||
14. Claim.extension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | ||||
Short | Additional content defined by implementations | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | false | ||||
Summary | false | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on Claim.extension . The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: | ||||
16. Claim.modifierExtension | |||||
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. | ||||
Short | Extensions that cannot be ignored | ||||
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. | ||||
Control | 0..* | ||||
Type | Extension | ||||
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them | ||||
Summary | false | ||||
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. | ||||
Alternate Names | extensions, user content | ||||
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) | ||||
Slicing | This element introduces a set of slices on Claim.modifierExtension . The slices are unordered and Open, and can be differentiated using the following discriminators: , and can be differentiated using the following discriminators: | ||||
18. Claim.careLevel | |||||
Definition | Code used for care level | ||||
Short | Code used for care level | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
20. Claim.created | |||||
Definition | Timestamp when the claim was created | ||||
Short | Timestamp when the claim was created | ||||
Control | 0..1 | ||||
Type | dateTime | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
22. Claim.dailyRate | |||||
Definition | Amount used for daily rate | ||||
Short | Amount used for daily rate | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
24. Claim.description | |||||
Definition | Description | ||||
Short | Description | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
26. Claim.fedTaxNumber | |||||
Definition | Federal tax number | ||||
Short | Federal tax number | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
28. Claim.grandTotal | |||||
Definition | Total amount for the claim | ||||
Short | Total amount for the claim | ||||
Control | 0..1 | ||||
Type | Money | ||||
Summary | true | ||||
30. Claim.hippsCode | |||||
Definition | Health Insurance Prospective Payment System (HIPPS) Code | ||||
Short | Health Insurance Prospective Payment System (HIPPS) Code | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
32. Claim.identifier | |||||
Definition | Identification key | ||||
Short | Identification key | ||||
Note | This is a business identifier, not a resource identifier (see discussion) | ||||
Control | 1..1 | ||||
Type | Identifier | ||||
Summary | true | ||||
34. Claim.insuredName | |||||
Definition | Insure's name - combines Last name, First name, Middle name | ||||
Short | Insure's name - combines Last name, First name, Middle name | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
36. Claim.insuredUniqueId | |||||
Definition | Insurance policy number | ||||
Short | Insurance policy number | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
38. Claim.nonCoveredCharges | |||||
Definition | Amount not covered in the claim | ||||
Short | Amount not covered in the claim | ||||
Control | 0..1 | ||||
Type | Money | ||||
Summary | true | ||||
40. Claim.npi | |||||
Definition | NPI Number | ||||
Short | NPI Number | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
42. Claim.payer | |||||
Definition | Payer name | ||||
Short | Payer name | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
44. Claim.period | |||||
Definition | The period for which charges are being submitted. | ||||
Short | The period for which charges are being submitted. | ||||
Control | 0..1 | ||||
Type | Extension(Period) (Extension Type: Period) | ||||
Summary | true | ||||
46. Claim.revCO | |||||
Definition | Revenue Code | ||||
Short | Revenue Code | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
48. Claim.serviceDate | |||||
Definition | Date of service for the claim | ||||
Short | Date of service for the claim | ||||
Control | 0..1 | ||||
Type | dateTime | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
50. Claim.serviceUnits | |||||
Definition | Days amount for service units | ||||
Short | Days amount for service units | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
52. Claim.status | |||||
Definition | Claim's status | ||||
Short | Claim's status | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true | ||||
54. Claim.subject | |||||
Definition | Patient subject reference | ||||
Short | Patient subject reference | ||||
Control | 1..1 | ||||
Type | Reference(Patient) | ||||
Summary | true | ||||
56. Claim.totalCharges | |||||
Definition | Transaction amount | ||||
Short | Transaction amount | ||||
Control | 0..1 | ||||
Type | Money | ||||
Summary | true | ||||
58. Claim.use | |||||
Definition | Fixed as: Claim | ||||
Short | Fixed as: Claim | ||||
Control | 0..1 | ||||
Type | string | ||||
Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
Summary | true |