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

Resource Profile: Claim

Official URL: https://ehi-export.pointclickcare.com//StructureDefinition/Claim Version: 0.1.0
Draft as of 2024-02-05 Computable Name: EHIClaim

Insurance Claim for the patient

Usage:

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

Formal Views of Profile Content

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

This structure is derived from DomainResource

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..*DomainResourceClaim
... careLevel Σ0..1stringCode used for care level
... created Σ0..1dateTimeTimestamp when the claim was created
... dailyRate Σ0..1stringAmount used for daily rate
... fedTaxNumber Σ0..1stringFederal tax number
... grandTotal Σ0..1MoneyTotal amount for the claim
... hippsCode Σ0..1stringHealth Insurance Prospective Payment System (HIPPS) Code
... identifier Σ1..1IdentifierIdentification key
... insuredName Σ0..1stringInsure's name - combines Last name, First name, Middle name
... insuredUniqueId Σ0..1stringInsurance policy number
... nonCoveredCharges Σ0..1MoneyAmount not covered in the claim
... npi Σ0..1stringNPI Number
... payer Σ0..1stringPayer name
... period Σ0..1periodThe period for which charges are being submitted.
... revCO Σ0..1stringRevenue Code
... serviceDate Σ0..1dateTimeDate of service for the claim
... serviceUnits Σ0..1stringDays amount for service units
... status Σ0..1stringClaim's status
... subject Σ1..1Reference(Patient)Patient subject reference
... totalCharges Σ0..1MoneyTransaction amount
... use Σ0..1stringFixed as: Claim

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..*DomainResourceClaim
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
Slice: Unordered, Open by value:url
... careLevel Σ0..1stringCode used for care level
... dailyRate Σ0..1stringAmount used for daily rate
... description Σ0..1stringDescription
... fedTaxNumber Σ0..1stringFederal tax number
... grandTotal Σ0..1MoneyTotal amount for the claim
... hippsCode Σ0..1stringHealth Insurance Prospective Payment System (HIPPS) Code
... identifier Σ1..1IdentifierIdentification key
... insuredName Σ0..1stringInsure's name - combines Last name, First name, Middle name
... insuredUniqueId Σ0..1stringInsurance policy number
... nonCoveredCharges Σ0..1MoneyAmount not covered in the claim
... npi Σ0..1stringNPI Number
... payer Σ0..1stringPayer name
... period Σ0..1periodThe period for which charges are being submitted.
... revCO Σ0..1stringRevenue Code
... serviceDate Σ0..1dateTimeDate of service for the claim
... serviceUnits Σ0..1stringDays amount for service units
... status Σ0..1stringClaim's status
... subject Σ1..1Reference(Patient)Patient subject reference
... totalCharges Σ0..1MoneyTransaction amount
... use Σ0..1stringFixed as: Claim

doco Documentation for this format

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf 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-4errorClaimIf 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-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..*DomainResourceClaim
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
Slice: Unordered, Open by value:url
... careLevel Σ0..1stringCode used for care level
... created Σ0..1dateTimeTimestamp when the claim was created
... dailyRate Σ0..1stringAmount used for daily rate
... description Σ0..1stringDescription
... fedTaxNumber Σ0..1stringFederal tax number
... grandTotal Σ0..1MoneyTotal amount for the claim
... hippsCode Σ0..1stringHealth Insurance Prospective Payment System (HIPPS) Code
... identifier Σ1..1IdentifierIdentification key
... insuredName Σ0..1stringInsure's name - combines Last name, First name, Middle name
... insuredUniqueId Σ0..1stringInsurance policy number
... nonCoveredCharges Σ0..1MoneyAmount not covered in the claim
... npi Σ0..1stringNPI Number
... payer Σ0..1stringPayer name
... period Σ0..1periodThe period for which charges are being submitted.
... revCO Σ0..1stringRevenue Code
... serviceDate Σ0..1dateTimeDate of service for the claim
... serviceUnits Σ0..1stringDays amount for service units
... status Σ0..1stringClaim's status
... subject Σ1..1Reference(Patient)Patient subject reference
... totalCharges Σ0..1MoneyTransaction amount
... use Σ0..1stringFixed as: Claim

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Claim.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf 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-4errorClaimIf 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-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust 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:

Differential View

This structure is derived from DomainResource

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..*DomainResourceClaim
... careLevel Σ0..1stringCode used for care level
... created Σ0..1dateTimeTimestamp when the claim was created
... dailyRate Σ0..1stringAmount used for daily rate
... fedTaxNumber Σ0..1stringFederal tax number
... grandTotal Σ0..1MoneyTotal amount for the claim
... hippsCode Σ0..1stringHealth Insurance Prospective Payment System (HIPPS) Code
... identifier Σ1..1IdentifierIdentification key
... insuredName Σ0..1stringInsure's name - combines Last name, First name, Middle name
... insuredUniqueId Σ0..1stringInsurance policy number
... nonCoveredCharges Σ0..1MoneyAmount not covered in the claim
... npi Σ0..1stringNPI Number
... payer Σ0..1stringPayer name
... period Σ0..1periodThe period for which charges are being submitted.
... revCO Σ0..1stringRevenue Code
... serviceDate Σ0..1dateTimeDate of service for the claim
... serviceUnits Σ0..1stringDays amount for service units
... status Σ0..1stringClaim's status
... subject Σ1..1Reference(Patient)Patient subject reference
... totalCharges Σ0..1MoneyTransaction amount
... use Σ0..1stringFixed as: Claim

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..*DomainResourceClaim
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
Slice: Unordered, Open by value:url
... careLevel Σ0..1stringCode used for care level
... dailyRate Σ0..1stringAmount used for daily rate
... description Σ0..1stringDescription
... fedTaxNumber Σ0..1stringFederal tax number
... grandTotal Σ0..1MoneyTotal amount for the claim
... hippsCode Σ0..1stringHealth Insurance Prospective Payment System (HIPPS) Code
... identifier Σ1..1IdentifierIdentification key
... insuredName Σ0..1stringInsure's name - combines Last name, First name, Middle name
... insuredUniqueId Σ0..1stringInsurance policy number
... nonCoveredCharges Σ0..1MoneyAmount not covered in the claim
... npi Σ0..1stringNPI Number
... payer Σ0..1stringPayer name
... period Σ0..1periodThe period for which charges are being submitted.
... revCO Σ0..1stringRevenue Code
... serviceDate Σ0..1dateTimeDate of service for the claim
... serviceUnits Σ0..1stringDays amount for service units
... status Σ0..1stringClaim's status
... subject Σ1..1Reference(Patient)Patient subject reference
... totalCharges Σ0..1MoneyTransaction amount
... use Σ0..1stringFixed as: Claim

doco Documentation for this format

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf 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-4errorClaimIf 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-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..*DomainResourceClaim
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
Slice: Unordered, Open by value:url
... careLevel Σ0..1stringCode used for care level
... created Σ0..1dateTimeTimestamp when the claim was created
... dailyRate Σ0..1stringAmount used for daily rate
... description Σ0..1stringDescription
... fedTaxNumber Σ0..1stringFederal tax number
... grandTotal Σ0..1MoneyTotal amount for the claim
... hippsCode Σ0..1stringHealth Insurance Prospective Payment System (HIPPS) Code
... identifier Σ1..1IdentifierIdentification key
... insuredName Σ0..1stringInsure's name - combines Last name, First name, Middle name
... insuredUniqueId Σ0..1stringInsurance policy number
... nonCoveredCharges Σ0..1MoneyAmount not covered in the claim
... npi Σ0..1stringNPI Number
... payer Σ0..1stringPayer name
... period Σ0..1periodThe period for which charges are being submitted.
... revCO Σ0..1stringRevenue Code
... serviceDate Σ0..1dateTimeDate of service for the claim
... serviceUnits Σ0..1stringDays amount for service units
... status Σ0..1stringClaim's status
... subject Σ1..1Reference(Patient)Patient subject reference
... totalCharges Σ0..1MoneyTransaction amount
... use Σ0..1stringFixed as: Claim

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Claim.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf 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-4errorClaimIf 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-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust 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