EHI Export Implementation Guide - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: Claim

Official URL: https://ehi-export.pointclickcare.com//StructureDefinition/Claim Version: 0.1.0
Draft as of 2025-12-10 Computable Name: EHIClaim

Insurance Claim for the patient.

Notes

The id element is not displayed in the snapshot tables. Refer to the detailed descriptions for the full definition.

Usages:

  • This Resource is not used by any profiles in this Implementation Guide

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* DomainResource Claim

Elements defined in Ancestors:id, meta, implicitRules, language, text, contained, extension, modifierExtension
... meta Σ 0..1 Meta Metadata about the resource
... 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.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Slice: Unordered, Open by value:url
... identifier Σ 1..1 Identifier Identification key
... subject Σ 1..1 Reference(Patient) Patient subject reference
... status Σ 0..1 string Claim's status
... revCO Σ 0..1 string Revenue Code
... description Σ 0..1 string Description
... hippsCode Σ 0..1 string Health Insurance Prospective Payment System (HIPPS) Code
... serviceDate Σ 0..1 dateTime Date of service for the claim
... serviceUnits Σ 0..1 string Days amount for service units
... totalCharges Σ 0..1 Money Transaction amount
... nonCoveredCharges Σ 0..1 Money Amount not covered in the claim
... grandTotal Σ 0..1 Money Total amount for the claim
... payer Σ 0..1 string Payer name
... npi Σ 0..1 string NPI Number
... insuredName Σ 0..1 string Insure's name - combines Last name, First name, Middle name
... insuredUniqueId Σ 0..1 string Insurance policy number
... fedTaxNumber Σ 0..1 string Federal tax number
... use Σ 0..1 string Fixed as: Claim
... created Σ 0..1 dateTime Timestamp when the claim was created
... period Σ 0..1 OrgPeriod(5.2.0) The period for which charges are being submitted.
... careLevel Σ 0..1 string Code used for care level
... dailyRate Σ 0..1 string Amount used for daily rate

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.language Base preferred Common Languages 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
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()

This structure is derived from DomainResource

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* DomainResource Claim

Elements defined in Ancestors:id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ 1..1 Identifier Identification key
... subject Σ 1..1 Reference(Patient) Patient subject reference
... status Σ 0..1 string Claim's status
... description Σ 0..1 string Description
... hippsCode Σ 0..1 string Health Insurance Prospective Payment System (HIPPS) Code
... serviceDate Σ 0..1 dateTime Date of service for the claim
... serviceUnits Σ 0..1 string Days amount for service units
... totalCharges Σ 0..1 Money Transaction amount
... nonCoveredCharges Σ 0..1 Money Amount not covered in the claim
... grandTotal Σ 0..1 Money Total amount for the claim
... payer Σ 0..1 string Payer name
... npi Σ 0..1 string NPI Number
... insuredName Σ 0..1 string Insure's name - combines Last name, First name, Middle name
... insuredUniqueId Σ 0..1 string Insurance policy number
... fedTaxNumber Σ 0..1 string Federal tax number
... use Σ 0..1 string Fixed as: Claim
... created Σ 0..1 dateTime Timestamp when the claim was created
... period Σ 0..1 OrgPeriod(5.2.0) The period for which charges are being submitted.
... careLevel Σ 0..1 string Code used for care level
... dailyRate Σ 0..1 string Amount used for daily rate

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* DomainResource Claim

Elements defined in Ancestors:id, meta, implicitRules, language, text, contained, extension, modifierExtension
... meta Σ 0..1 Meta Metadata about the resource
... 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.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Slice: Unordered, Open by value:url
... identifier Σ 1..1 Identifier Identification key
... subject Σ 1..1 Reference(Patient) Patient subject reference
... status Σ 0..1 string Claim's status
... revCO Σ 0..1 string Revenue Code
... description Σ 0..1 string Description
... hippsCode Σ 0..1 string Health Insurance Prospective Payment System (HIPPS) Code
... serviceDate Σ 0..1 dateTime Date of service for the claim
... serviceUnits Σ 0..1 string Days amount for service units
... totalCharges Σ 0..1 Money Transaction amount
... nonCoveredCharges Σ 0..1 Money Amount not covered in the claim
... grandTotal Σ 0..1 Money Total amount for the claim
... payer Σ 0..1 string Payer name
... npi Σ 0..1 string NPI Number
... insuredName Σ 0..1 string Insure's name - combines Last name, First name, Middle name
... insuredUniqueId Σ 0..1 string Insurance policy number
... fedTaxNumber Σ 0..1 string Federal tax number
... use Σ 0..1 string Fixed as: Claim
... created Σ 0..1 dateTime Timestamp when the claim was created
... period Σ 0..1 OrgPeriod(5.2.0) The period for which charges are being submitted.
... careLevel Σ 0..1 string Code used for care level
... dailyRate Σ 0..1 string Amount used for daily rate

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.language Base preferred Common Languages 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
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()

This structure is derived from DomainResource

Summary

Mandatory: 0 element(2 nested mandatory elements)

Structures

This structure refers to these other structures:

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* DomainResource Claim

Elements defined in Ancestors:id, meta, implicitRules, language, text, contained, extension, modifierExtension
... meta Σ 0..1 Meta Metadata about the resource
... 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.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Slice: Unordered, Open by value:url
... identifier Σ 1..1 Identifier Identification key
... subject Σ 1..1 Reference(Patient) Patient subject reference
... status Σ 0..1 string Claim's status
... revCO Σ 0..1 string Revenue Code
... description Σ 0..1 string Description
... hippsCode Σ 0..1 string Health Insurance Prospective Payment System (HIPPS) Code
... serviceDate Σ 0..1 dateTime Date of service for the claim
... serviceUnits Σ 0..1 string Days amount for service units
... totalCharges Σ 0..1 Money Transaction amount
... nonCoveredCharges Σ 0..1 Money Amount not covered in the claim
... grandTotal Σ 0..1 Money Total amount for the claim
... payer Σ 0..1 string Payer name
... npi Σ 0..1 string NPI Number
... insuredName Σ 0..1 string Insure's name - combines Last name, First name, Middle name
... insuredUniqueId Σ 0..1 string Insurance policy number
... fedTaxNumber Σ 0..1 string Federal tax number
... use Σ 0..1 string Fixed as: Claim
... created Σ 0..1 dateTime Timestamp when the claim was created
... period Σ 0..1 OrgPeriod(5.2.0) The period for which charges are being submitted.
... careLevel Σ 0..1 string Code used for care level
... dailyRate Σ 0..1 string Amount used for daily rate

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.language Base preferred Common Languages 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
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()

Differential View

This structure is derived from DomainResource

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* DomainResource Claim

Elements defined in Ancestors:id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ 1..1 Identifier Identification key
... subject Σ 1..1 Reference(Patient) Patient subject reference
... status Σ 0..1 string Claim's status
... description Σ 0..1 string Description
... hippsCode Σ 0..1 string Health Insurance Prospective Payment System (HIPPS) Code
... serviceDate Σ 0..1 dateTime Date of service for the claim
... serviceUnits Σ 0..1 string Days amount for service units
... totalCharges Σ 0..1 Money Transaction amount
... nonCoveredCharges Σ 0..1 Money Amount not covered in the claim
... grandTotal Σ 0..1 Money Total amount for the claim
... payer Σ 0..1 string Payer name
... npi Σ 0..1 string NPI Number
... insuredName Σ 0..1 string Insure's name - combines Last name, First name, Middle name
... insuredUniqueId Σ 0..1 string Insurance policy number
... fedTaxNumber Σ 0..1 string Federal tax number
... use Σ 0..1 string Fixed as: Claim
... created Σ 0..1 dateTime Timestamp when the claim was created
... period Σ 0..1 OrgPeriod(5.2.0) The period for which charges are being submitted.
... careLevel Σ 0..1 string Code used for care level
... dailyRate Σ 0..1 string Amount used for daily rate

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* DomainResource Claim

Elements defined in Ancestors:id, meta, implicitRules, language, text, contained, extension, modifierExtension
... meta Σ 0..1 Meta Metadata about the resource
... 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.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Slice: Unordered, Open by value:url
... identifier Σ 1..1 Identifier Identification key
... subject Σ 1..1 Reference(Patient) Patient subject reference
... status Σ 0..1 string Claim's status
... revCO Σ 0..1 string Revenue Code
... description Σ 0..1 string Description
... hippsCode Σ 0..1 string Health Insurance Prospective Payment System (HIPPS) Code
... serviceDate Σ 0..1 dateTime Date of service for the claim
... serviceUnits Σ 0..1 string Days amount for service units
... totalCharges Σ 0..1 Money Transaction amount
... nonCoveredCharges Σ 0..1 Money Amount not covered in the claim
... grandTotal Σ 0..1 Money Total amount for the claim
... payer Σ 0..1 string Payer name
... npi Σ 0..1 string NPI Number
... insuredName Σ 0..1 string Insure's name - combines Last name, First name, Middle name
... insuredUniqueId Σ 0..1 string Insurance policy number
... fedTaxNumber Σ 0..1 string Federal tax number
... use Σ 0..1 string Fixed as: Claim
... created Σ 0..1 dateTime Timestamp when the claim was created
... period Σ 0..1 OrgPeriod(5.2.0) The period for which charges are being submitted.
... careLevel Σ 0..1 string Code used for care level
... dailyRate Σ 0..1 string Amount used for daily rate

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.language Base preferred Common Languages 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
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()

This structure is derived from DomainResource

Summary

Mandatory: 0 element(2 nested mandatory elements)

Structures

This structure refers to these other structures:

 

​Other representations of profile: CSV, Excel, Schematron