Claim

Claim

draftFHIR Core package4.3.0resource27 key elements

A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.

Metadata

hl7.org/fhir
Canonical URL
http://hl7.org/fhir/StructureDefinition/Claim
ID
Claim
Type
Claim
Base Definition
DomainResource
Derivation
specialization
Mandatory and Must-Support Elements

Elements with cardinality > 0 or marked as Must Support (S)

PathCard.TypeFlagsDescription
status1..1
code
1+
active | cancelled | draft | entered-in-error
type1..1
CodeableConcept
1+
Category or discipline
use1..1
code
1+
claim | preauthorization | predetermination
patient1..1
Reference
1+
The recipient of the products and services
created1..1
dateTime
1+
Resource creation date
provider1..1
Reference
1+
Party responsible for the claim
priority1..1
CodeableConcept
1+
Desired processing ugency
payee.type1..1
CodeableConcept
1+
Category of recipient
careTeam.sequence1..1
positiveInt
1+
Order of care team
careTeam.provider1..1
Reference
1+
Practitioner or organization
supportingInfo.sequence1..1
positiveInt
1+
Information instance identifier
supportingInfo.category1..1
CodeableConcept
1+
Classification of the supplied information
diagnosis.sequence1..1
positiveInt
1+
Diagnosis instance identifier
diagnosis.diagnosis[x]1..1
CodeableConceptReference
1+
Nature of illness or problem
procedure.sequence1..1
positiveInt
1+
Procedure instance identifier
procedure.procedure[x]1..1
CodeableConceptReference
1+
Specific clinical procedure
insurance1..*
BackboneElement
1+
Patient insurance information
insurance.sequence1..1
positiveInt
1+
Insurance instance identifier
insurance.focal1..1
boolean
1+
Coverage to be used for adjudication
insurance.coverage1..1
Reference
1+
Insurance information
accident.date1..1
date
1+
When the incident occurred
item.sequence1..1
positiveInt
1+
Item instance identifier
item.productOrService1..1
CodeableConcept
1+
Billing, service, product, or drug code
item.detail.sequence1..1
positiveInt
1+
Item instance identifier
item.detail.productOrService1..1
CodeableConcept
1+
Billing, service, product, or drug code
item.detail.subDetail.sequence1..1
positiveInt
1+
Item instance identifier
item.detail.subDetail.productOrService1..1
CodeableConcept
1+
Billing, service, product, or drug code