Claim
Claim
draftResource175 elementsv5.0.0
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
- Base Definition
- Derivation
- specialization
- Publisher
- Health Level Seven International (Financial Management)
- Version
- 5.0.0
- Purpose
- The Claim resource is used by providers to exchange services and products rendered to patients or planned to be rendered with insurers for reimbuserment. It is also used by insurers to exchange claims information with statutory reporting and data analytics firms.
| Path | Card. | Type | Description |
|---|---|---|---|
Claim | 0..* | Claim, Pre-determination or Pre-authorization | |
id | 0..1 | string | Logical id of this artifact |
meta | 0..1 | Metadata about the resource | |
implicitRules | 0..1 | uri | A set of rules under which this content was created |
language | 0..1 | code | Language of the resource contentrequired: all-languages |
text | 0..1 | Text summary of the resource, for human interpretation | |
contained | 0..* | Resource | Contained, inline Resources |
extension | 0..* | Additional content defined by implementations | |
modifierExtension | 0..* | Extensions that cannot be ignored | |
identifier | 0..* | Business Identifier for claim | |
traceNumber | 0..* | Number for tracking | |
status | 1..1 | code | active | cancelled | draft | entered-in-errorrequired: fm-status |
type | 1..1 | Category or disciplineextensible: claim-type | |
subType | 0..1 | More granular claim typeexample: claim-subtype | |
use | 1..1 | code | claim | preauthorization | predeterminationrequired: claim-use |
patient | 1..1 | The recipient of the products and services | |
billablePeriod | 0..1 | Relevant time frame for the claim | |
created | 1..1 | dateTime | Resource creation date |
enterer | 0..1 | Author of the claim | |
insurer | 0..1 | Target | |
provider | 0..1 | Party responsible for the claim | |
priority | 0..1 | Desired processing urgencyexample: process-priority | |
fundsReserve | 0..1 | For whom to reserve fundsexample: fundsreserve | |
related | 0..* | BackboneElement | Prior or corollary claims |
prescription | 0..1 | Prescription authorizing services and products | |
originalPrescription | 0..1 | Original prescription if superseded by fulfiller | |
payee | 0..1 | BackboneElement | Recipient of benefits payable |
referral | 0..1 | Treatment referral | |
encounter | 0..* | Encounters associated with the listed treatments | |
facility | 0..1 | Servicing facility | |
diagnosisRelatedGroup | 0..1 | Package billing codeexample: ex-diagnosisrelatedgroup | |
event | 0..* | BackboneElement | Event information |
careTeam | 0..* | BackboneElement | Members of the care team |
supportingInfo | 0..* | BackboneElement | Supporting information |
diagnosis | 0..* | BackboneElement | Pertinent diagnosis information |
procedure | 0..* | BackboneElement | Clinical procedures performed |
insurance | 0..* | BackboneElement | Patient insurance information |
accident | 0..1 | BackboneElement | Details of the event |
patientPaid | 0..1 | Paid by the patient | |
item | 0..* | BackboneElement | Product or service provided |
total | 0..1 | Total claim cost |