EHI Export Implementation Guide
0.1.0 - ci-build

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 2025-01-29 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.

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* DomainResource Claim
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
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
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
dom-6: A resource should have narrative for robust management
... meta Σ 0..1 Meta Metadata about the resource
ele-1: All FHIR elements must have a @value or children
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
ele-1: All FHIR elements must have a @value or children
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding

ele-1: All FHIR elements must have a @value or children
... text 0..1 Narrative Text summary of the resource, for human interpretation
ele-1: All FHIR elements must have a @value or children
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Slice: Unordered, Open by value:url
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... 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(5.1.0) 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

PathConformanceValueSetURI
Claim.languagepreferredCommonLanguages
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
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

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* DomainResource Claim
... 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(5.1.0) 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 & Constraintsdoco
.. Claim 0..* DomainResource Claim
... 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
... 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(5.1.0) 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

PathConformanceValueSetURI
Claim.languagepreferredCommonLanguages
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
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:

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* DomainResource Claim
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
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
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
dom-6: A resource should have narrative for robust management
... meta Σ 0..1 Meta Metadata about the resource
ele-1: All FHIR elements must have a @value or children
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
ele-1: All FHIR elements must have a @value or children
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding

ele-1: All FHIR elements must have a @value or children
... text 0..1 Narrative Text summary of the resource, for human interpretation
ele-1: All FHIR elements must have a @value or children
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Slice: Unordered, Open by value:url
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... 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(5.1.0) 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

PathConformanceValueSetURI
Claim.languagepreferredCommonLanguages
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
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()

Differential View

This structure is derived from DomainResource

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* DomainResource Claim
... 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(5.1.0) 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 & Constraintsdoco
.. Claim 0..* DomainResource Claim
... 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
... 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(5.1.0) 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

PathConformanceValueSetURI
Claim.languagepreferredCommonLanguages
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
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