MedNet interface implementation guide
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MedNet interface implementation guide - Downloaded Version 0.20.0 See the Directory of published versions

Resource Profile: MedNet Interface (MNI) - Claim

Official URL: https://mednet.swiss/fhir/StructureDefinition/mni-claim Version: 0.20.0
Active as of 2025-12-19 Computable Name: MNIClaim

Copyright/Legal: novcom AG

MedNet Interface (MNI) - Claim Profile

Usages:

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..* Claim MedNet Interface (MNI) - Claim
... id Σ 0..1 id The id is unique within the space of all resources of the same type on the same server It can be any combination of upper- or lower-case ASCII letters 'A'..'Z', and 'a'..'z', numerals ('0'..'9'), '-' and '.' with a length limit of 64 characters. (This might be an integer, an un-prefixed OID, UUID or any other identifier pattern that meets these constraints.)
... Slices for identifier S 0..* Identifier Business Identifier for claim
Slice: Unordered, Open by value:system, value:type.coding.system, value:type.coding.code
.... identifier:accident S 0..1 Identifier accident identifiers
..... type SΣ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
...... coding SΣ 1..1 Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: https://mednet.swiss/fhir/CodeSystem/mni-identifierType
....... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: accident-id
....... display SΣ 0..1 string Representation defined by the system
Fixed Value: accident identifier
..... system SΣ 0..1 uri Uri that defines the Software that delivers the accident ID. for example https://mysoftware.ch/accidentDB/123456
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 1..1 string The value that is unique
Example General: 123456
.... identifier:disability S 0..1 Identifier disability identifiers
..... type SΣ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
...... coding SΣ 1..1 Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: https://mednet.swiss/fhir/CodeSystem/mni-identifierType
....... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: disability-id
....... display SΣ 0..1 string Representation defined by the system
Fixed Value: disability identifier
..... system SΣ 0..1 uri Uri that defines the Software that delivers the disability ID. for example https://mysoftware.ch/disabilityDB/123456
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 1..1 string The value that is unique
Example General: 123456
.... identifier:militaryIncident S 0..1 Identifier militaryIncident identifiers
..... type SΣ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
...... coding SΣ 1..1 Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: https://mednet.swiss/fhir/CodeSystem/mni-identifierType
....... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: militaryIncident-id
....... display SΣ 0..1 string Representation defined by the system
Fixed Value: military incident identifier
..... system SΣ 0..1 uri Uri that defines the Software that delivers the militaryIncident ID. for example https://mysoftware.ch/militaryIncidentDB/123456
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 1..1 string The value that is unique
Example General: 123456
... status ?!SΣ 1..1 code Fixed value:active. Only active claim data are usefull
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Fixed Value: active
... use SΣ 1..1 code Fixed value:claim
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Fixed Value: claim
... patient SΣ 1..1 Reference(MedNet Interface (MNI) - Patient) Link to the patient concerned by the claim
... created SΣ 1..1 dateTime The date or dateTime the claim has been created
... provider SΣ 1..1 Reference(MedNet Interface (MNI) - PractitionerRole) The mednet practitioner responsible for the claim
... priority SΣ 1..1 CodeableConcept stat (Immediately in real time) | normal (With best effort) | deferred (Later, when possible)
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
... insurance SΣ 1..* BackboneElement Patient insurance information
.... sequence SΣ 1..1 positiveInt The sequence element in Claim.insurance is used to indicate the order of insurance coverage priority. It defines which insurance is primary, secondary, tertiary, etc., in situations where a patient has multiple active insurance policies. sequence = 1 it is the primary insurance
.... focal SΣ 1..1 boolean indicates which insurance coverage is currently responsible for adjudicating (processing and paying) the claim
.... coverage SΣ 1..1 Reference(MedNet Interface (MNI) - Coverage) Insurance information
... accident S 0..1 BackboneElement Details of the event
.... date S 1..1 date When the incident occurred
... item S 0..* BackboneElement Product or service provided
.... sequence S 1..1 positiveInt unique line number to each item (service or product) listed in the claim
.... category S 1..1 CodeableConcept Fixed category : TARDOC
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
..... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:system, value:code
...... coding:TARDOC SΣ 1..1 Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://forum-datenaustausch.ch/tariff
....... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: 007
....... display SΣ 0..1 string Representation defined by the system
Fixed Value: TARDOC
.... productOrService S 1..1 CodeableConcept The tariff position
Binding: USCLSCodes (example): Allowable service and product codes.
..... coding SΣ 0..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://forum-datenaustausch.ch/tariff/TMA
...... code SΣ 1..1 code The tariff position code
...... display SΣ 0..1 string The tariff position corresponding text

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.identifier:accident.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Claim.identifier:disability.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Claim.identifier:militaryIncident.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Claim.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Claim.type Base required BFS Medizinische Statistik - 20 1.3.V01 - Behandlungsart / Type de prise en charge / Genere di trattamento 📦3.3.0 CH Term v3.3
Claim.use Base required Use 📍4.0.1 FHIR Std.
Claim.priority Base example Process Priority Codes 📍4.0.1 FHIR Std.
Claim.item.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item.productOrService Base example USCLS Codes 📍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())

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim MedNet Interface (MNI) - Claim
... id 0..1 id The id is unique within the space of all resources of the same type on the same server It can be any combination of upper- or lower-case ASCII letters 'A'..'Z', and 'a'..'z', numerals ('0'..'9'), '-' and '.' with a length limit of 64 characters. (This might be an integer, an un-prefixed OID, UUID or any other identifier pattern that meets these constraints.)
... implicitRules 0..0 A set of rules under which this content was created
... modifierExtension 0..0 Extension
.... identifier:accident S 0..1 Identifier accident identifiers
..... use 0..0 usual | official | temp | secondary | old (If known)
..... type S 1..1 CodeableConcept Description of identifier
...... coding S 1..1 Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
Fixed Value: https://mednet.swiss/fhir/CodeSystem/mni-identifierType
....... code S 1..1 code Symbol in syntax defined by the system
Fixed Value: accident-id
....... display S 0..1 string Representation defined by the system
Fixed Value: accident identifier
..... system S 0..1 uri Uri that defines the Software that delivers the accident ID. for example https://mysoftware.ch/accidentDB/123456
..... value S 1..1 string The value that is unique
.... identifier:disability S 0..1 Identifier disability identifiers
..... use 0..0 usual | official | temp | secondary | old (If known)
..... type S 1..1 CodeableConcept Description of identifier
...... coding S 1..1 Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
Fixed Value: https://mednet.swiss/fhir/CodeSystem/mni-identifierType
....... code S 1..1 code Symbol in syntax defined by the system
Fixed Value: disability-id
....... display S 0..1 string Representation defined by the system
Fixed Value: disability identifier
..... system S 0..1 uri Uri that defines the Software that delivers the disability ID. for example https://mysoftware.ch/disabilityDB/123456
..... value S 1..1 string The value that is unique
.... identifier:militaryIncident S 0..1 Identifier militaryIncident identifiers
..... use 0..0 usual | official | temp | secondary | old (If known)
..... type S 1..1 CodeableConcept Description of identifier
...... coding S 1..1 Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
Fixed Value: https://mednet.swiss/fhir/CodeSystem/mni-identifierType
....... code S 1..1 code Symbol in syntax defined by the system
Fixed Value: militaryIncident-id
....... display S 0..1 string Representation defined by the system
Fixed Value: military incident identifier
..... system S 0..1 uri Uri that defines the Software that delivers the militaryIncident ID. for example https://mysoftware.ch/militaryIncidentDB/123456
..... value S 1..1 string The value that is unique
... status S 1..1 code Fixed value:active. Only active claim data are usefull
Fixed Value: active
... type S 1..1 CodeableConcept 1 (Ambulant/Ambulatoire/Outpatient) | 3 (stationär/Hospitalisé/Inpatient) | 9 (unbekannt/Inconnu/Unknown)
Binding: BFS Medizinische Statistik - 20 1.3.V01 - Behandlungsart / Type de prise en charge / Genere di trattamento (required)
... use S 1..1 code Fixed value:claim
Fixed Value: claim
... patient S 1..1 Reference(MedNet Interface (MNI) - Patient) Link to the patient concerned by the claim
... created S 1..1 dateTime The date or dateTime the claim has been created
... provider S 1..1 Reference(MedNet Interface (MNI) - PractitionerRole) The mednet practitioner responsible for the claim
... priority S 1..1 CodeableConcept stat (Immediately in real time) | normal (With best effort) | deferred (Later, when possible)
... insurance S 1..* BackboneElement Patient insurance information
.... modifierExtension 0..0 Extension
.... sequence S 1..1 positiveInt The sequence element in Claim.insurance is used to indicate the order of insurance coverage priority. It defines which insurance is primary, secondary, tertiary, etc., in situations where a patient has multiple active insurance policies. sequence = 1 it is the primary insurance
.... focal S 1..1 boolean indicates which insurance coverage is currently responsible for adjudicating (processing and paying) the claim
.... coverage S 1..1 Reference(MedNet Interface (MNI) - Coverage) Insurance information
... accident S 0..1 BackboneElement Details of the event
.... modifierExtension 0..0 Extension
.... date S 1..1 date When the incident occurred
... item S 0..* BackboneElement Product or service provided
.... modifierExtension 0..0 Extension
.... sequence S 1..1 positiveInt unique line number to each item (service or product) listed in the claim
.... category S 1..1 CodeableConcept Fixed category : TARDOC
..... Slices for coding 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:system, value:code
...... coding:TARDOC S 1..1 Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
Fixed Value: http://forum-datenaustausch.ch/tariff
....... code S 1..1 code Symbol in syntax defined by the system
Fixed Value: 007
....... display S 0..1 string Representation defined by the system
Fixed Value: TARDOC
.... productOrService S 1..1 CodeableConcept The tariff position
..... coding S 0..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
Fixed Value: http://forum-datenaustausch.ch/tariff/TMA
...... code S 1..1 code The tariff position code
...... display S 0..1 string The tariff position corresponding text

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Claim.type Base required BFS Medizinische Statistik - 20 1.3.V01 - Behandlungsart / Type de prise en charge / Genere di trattamento 📦3.3.0 CH Term v3.3
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim MedNet Interface (MNI) - Claim
... id Σ 0..1 id The id is unique within the space of all resources of the same type on the same server It can be any combination of upper- or lower-case ASCII letters 'A'..'Z', and 'a'..'z', numerals ('0'..'9'), '-' and '.' with a length limit of 64 characters. (This might be an integer, an un-prefixed OID, UUID or any other identifier pattern that meets these constraints.)
... meta Σ 0..1 Meta Metadata about the resource
... 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
... Slices for identifier S 0..* Identifier Business Identifier for claim
Slice: Unordered, Open by value:system, value:type.coding.system, value:type.coding.code
.... identifier:accident S 0..1 Identifier accident identifiers
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... type SΣ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ 1..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: https://mednet.swiss/fhir/CodeSystem/mni-identifierType
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: accident-id
....... display SΣ 0..1 string Representation defined by the system
Fixed Value: accident identifier
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... system SΣ 0..1 uri Uri that defines the Software that delivers the accident ID. for example https://mysoftware.ch/accidentDB/123456
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 1..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:disability S 0..1 Identifier disability identifiers
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... type SΣ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ 1..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: https://mednet.swiss/fhir/CodeSystem/mni-identifierType
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: disability-id
....... display SΣ 0..1 string Representation defined by the system
Fixed Value: disability identifier
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... system SΣ 0..1 uri Uri that defines the Software that delivers the disability ID. for example https://mysoftware.ch/disabilityDB/123456
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 1..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:militaryIncident S 0..1 Identifier militaryIncident identifiers
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... type SΣ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ 1..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: https://mednet.swiss/fhir/CodeSystem/mni-identifierType
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: militaryIncident-id
....... display SΣ 0..1 string Representation defined by the system
Fixed Value: military incident identifier
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... system SΣ 0..1 uri Uri that defines the Software that delivers the militaryIncident ID. for example https://mysoftware.ch/militaryIncidentDB/123456
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 1..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code Fixed value:active. Only active claim data are usefull
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Fixed Value: active
... type SΣ 1..1 CodeableConcept 1 (Ambulant/Ambulatoire/Outpatient) | 3 (stationär/Hospitalisé/Inpatient) | 9 (unbekannt/Inconnu/Unknown)
Binding: BFS Medizinische Statistik - 20 1.3.V01 - Behandlungsart / Type de prise en charge / Genere di trattamento (required)
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code Fixed value:claim
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Fixed Value: claim
... patient SΣ 1..1 Reference(MedNet Interface (MNI) - Patient) Link to the patient concerned by the claim
... billablePeriod Σ 0..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime The date or dateTime the claim has been created
... enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
... insurer Σ 0..1 Reference(Organization) Target
... provider SΣ 1..1 Reference(MedNet Interface (MNI) - PractitionerRole) The mednet practitioner responsible for the claim
... priority SΣ 1..1 CodeableConcept stat (Immediately in real time) | normal (With best effort) | deferred (Later, when possible)
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
... fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... related 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 0..1 Reference(Claim) Reference to the related claim
.... relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
.... reference 0..1 Identifier File or case reference
... prescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee 0..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
.... party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
... referral 0..1 Reference(ServiceRequest) Treatment referral
... facility 0..1 Reference(Location) Servicing facility
... careTeam 0..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Order of care team
.... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
.... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
... supportingInfo 0..* BackboneElement Supporting information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Information instance identifier
.... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
.... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
.... timing[x] 0..1 When it occurred
..... timingDate date
..... timingPeriod Period
.... value[x] 0..1 Data to be provided
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
.... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
... diagnosis 0..* BackboneElement Pertinent diagnosis information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
.... type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
.... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
.... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
.... udi 0..* Reference(Device) Unique device identifier
... insurance SΣ 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... sequence SΣ 1..1 positiveInt The sequence element in Claim.insurance is used to indicate the order of insurance coverage priority. It defines which insurance is primary, secondary, tertiary, etc., in situations where a patient has multiple active insurance policies. sequence = 1 it is the primary insurance
.... focal SΣ 1..1 boolean indicates which insurance coverage is currently responsible for adjudicating (processing and paying) the claim
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage SΣ 1..1 Reference(MedNet Interface (MNI) - Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef 0..* string Prior authorization reference number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... accident S 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... date S 1..1 date When the incident occurred
.... type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
.... location[x] 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... item S 0..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... sequence S 1..1 positiveInt unique line number to each item (service or product) listed in the claim
.... careTeamSequence 0..* positiveInt Applicable careTeam members
.... diagnosisSequence 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence 0..* positiveInt Applicable exception and supporting information
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category S 1..1 CodeableConcept Fixed category : TARDOC
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:system, value:code
...... coding:TARDOC SΣ 1..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://forum-datenaustausch.ch/tariff
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: 007
....... display SΣ 0..1 string Representation defined by the system
Fixed Value: TARDOC
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text Σ 0..1 string Plain text representation of the concept
.... productOrService S 1..1 CodeableConcept The tariff position
Binding: USCLSCodes (example): Allowable service and product codes.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 0..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://forum-datenaustausch.ch/tariff/TMA
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code The tariff position code
...... display SΣ 0..1 string The tariff position corresponding text
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text Σ 0..1 string Plain text representation of the concept
.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... udi 0..* Reference(Device) Unique device identifier
.... bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
.... encounter 0..* Reference(Encounter) Encounters related to this billed item
.... detail 0..* BackboneElement Product or service provided
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Item instance identifier
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
..... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... udi 0..* Reference(Device) Unique device identifier
..... subDetail 0..* BackboneElement Product or service provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 positiveInt Item instance identifier
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
...... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... udi 0..* Reference(Device) Unique device identifier
... total 0..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Claim.identifier:accident.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Claim.identifier:disability.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Claim.identifier:militaryIncident.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Claim.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Claim.type Base required BFS Medizinische Statistik - 20 1.3.V01 - Behandlungsart / Type de prise en charge / Genere di trattamento 📦3.3.0 CH Term v3.3
Claim.subType Base example Example Claim SubType Codes 📍4.0.1 FHIR Std.
Claim.use Base required Use 📍4.0.1 FHIR Std.
Claim.priority Base example Process Priority Codes 📍4.0.1 FHIR Std.
Claim.fundsReserve Base example FundsReserve 📍4.0.1 FHIR Std.
Claim.related.relationship Base example Example Related Claim Relationship Codes 📍4.0.1 FHIR Std.
Claim.payee.type Base example PayeeType 📍4.0.1 FHIR Std.
Claim.careTeam.role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
Claim.careTeam.qualification Base example Example Provider Qualification Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo.​code Base example Exception Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 FHIR Std.
Claim.procedure.type Base example Example Procedure Type Codes 📍4.0.1 FHIR Std.
Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.0.1 FHIR Std.
Claim.accident.type Base extensible ActIncidentCode 📦3.0.0 THO v7.0
Claim.item.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item.location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
Claim.item.bodySite Base example Oral Site Codes 📍4.0.1 FHIR Std.
Claim.item.subSite Base example Surface Codes 📍4.0.1 FHIR Std.
Claim.item.detail.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item.detail.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item.detail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item.detail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item.detail.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​programCode Base example Example Program Reason Codes 📍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 Claim

Summary

Mandatory: 0 element(22 nested mandatory elements)
Must-Support: 50 elements
Fixed: 15 elements
Prohibited: 8 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element 3 is sliced based on the values of Claim.identifier
  • The element 2 is sliced based on the values of Claim.item.category.coding

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim MedNet Interface (MNI) - Claim
... id Σ 0..1 id The id is unique within the space of all resources of the same type on the same server It can be any combination of upper- or lower-case ASCII letters 'A'..'Z', and 'a'..'z', numerals ('0'..'9'), '-' and '.' with a length limit of 64 characters. (This might be an integer, an un-prefixed OID, UUID or any other identifier pattern that meets these constraints.)
... Slices for identifier S 0..* Identifier Business Identifier for claim
Slice: Unordered, Open by value:system, value:type.coding.system, value:type.coding.code
.... identifier:accident S 0..1 Identifier accident identifiers
..... type SΣ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
...... coding SΣ 1..1 Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: https://mednet.swiss/fhir/CodeSystem/mni-identifierType
....... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: accident-id
....... display SΣ 0..1 string Representation defined by the system
Fixed Value: accident identifier
..... system SΣ 0..1 uri Uri that defines the Software that delivers the accident ID. for example https://mysoftware.ch/accidentDB/123456
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 1..1 string The value that is unique
Example General: 123456
.... identifier:disability S 0..1 Identifier disability identifiers
..... type SΣ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
...... coding SΣ 1..1 Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: https://mednet.swiss/fhir/CodeSystem/mni-identifierType
....... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: disability-id
....... display SΣ 0..1 string Representation defined by the system
Fixed Value: disability identifier
..... system SΣ 0..1 uri Uri that defines the Software that delivers the disability ID. for example https://mysoftware.ch/disabilityDB/123456
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 1..1 string The value that is unique
Example General: 123456
.... identifier:militaryIncident S 0..1 Identifier militaryIncident identifiers
..... type SΣ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
...... coding SΣ 1..1 Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: https://mednet.swiss/fhir/CodeSystem/mni-identifierType
....... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: militaryIncident-id
....... display SΣ 0..1 string Representation defined by the system
Fixed Value: military incident identifier
..... system SΣ 0..1 uri Uri that defines the Software that delivers the militaryIncident ID. for example https://mysoftware.ch/militaryIncidentDB/123456
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 1..1 string The value that is unique
Example General: 123456
... status ?!SΣ 1..1 code Fixed value:active. Only active claim data are usefull
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Fixed Value: active
... use SΣ 1..1 code Fixed value:claim
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Fixed Value: claim
... patient SΣ 1..1 Reference(MedNet Interface (MNI) - Patient) Link to the patient concerned by the claim
... created SΣ 1..1 dateTime The date or dateTime the claim has been created
... provider SΣ 1..1 Reference(MedNet Interface (MNI) - PractitionerRole) The mednet practitioner responsible for the claim
... priority SΣ 1..1 CodeableConcept stat (Immediately in real time) | normal (With best effort) | deferred (Later, when possible)
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
... insurance SΣ 1..* BackboneElement Patient insurance information
.... sequence SΣ 1..1 positiveInt The sequence element in Claim.insurance is used to indicate the order of insurance coverage priority. It defines which insurance is primary, secondary, tertiary, etc., in situations where a patient has multiple active insurance policies. sequence = 1 it is the primary insurance
.... focal SΣ 1..1 boolean indicates which insurance coverage is currently responsible for adjudicating (processing and paying) the claim
.... coverage SΣ 1..1 Reference(MedNet Interface (MNI) - Coverage) Insurance information
... accident S 0..1 BackboneElement Details of the event
.... date S 1..1 date When the incident occurred
... item S 0..* BackboneElement Product or service provided
.... sequence S 1..1 positiveInt unique line number to each item (service or product) listed in the claim
.... category S 1..1 CodeableConcept Fixed category : TARDOC
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
..... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:system, value:code
...... coding:TARDOC SΣ 1..1 Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://forum-datenaustausch.ch/tariff
....... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: 007
....... display SΣ 0..1 string Representation defined by the system
Fixed Value: TARDOC
.... productOrService S 1..1 CodeableConcept The tariff position
Binding: USCLSCodes (example): Allowable service and product codes.
..... coding SΣ 0..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://forum-datenaustausch.ch/tariff/TMA
...... code SΣ 1..1 code The tariff position code
...... display SΣ 0..1 string The tariff position corresponding text

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.identifier:accident.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Claim.identifier:disability.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Claim.identifier:militaryIncident.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Claim.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Claim.type Base required BFS Medizinische Statistik - 20 1.3.V01 - Behandlungsart / Type de prise en charge / Genere di trattamento 📦3.3.0 CH Term v3.3
Claim.use Base required Use 📍4.0.1 FHIR Std.
Claim.priority Base example Process Priority Codes 📍4.0.1 FHIR Std.
Claim.item.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item.productOrService Base example USCLS Codes 📍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())

Differential View

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim MedNet Interface (MNI) - Claim
... id 0..1 id The id is unique within the space of all resources of the same type on the same server It can be any combination of upper- or lower-case ASCII letters 'A'..'Z', and 'a'..'z', numerals ('0'..'9'), '-' and '.' with a length limit of 64 characters. (This might be an integer, an un-prefixed OID, UUID or any other identifier pattern that meets these constraints.)
... implicitRules 0..0 A set of rules under which this content was created
... modifierExtension 0..0 Extension
.... identifier:accident S 0..1 Identifier accident identifiers
..... use 0..0 usual | official | temp | secondary | old (If known)
..... type S 1..1 CodeableConcept Description of identifier
...... coding S 1..1 Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
Fixed Value: https://mednet.swiss/fhir/CodeSystem/mni-identifierType
....... code S 1..1 code Symbol in syntax defined by the system
Fixed Value: accident-id
....... display S 0..1 string Representation defined by the system
Fixed Value: accident identifier
..... system S 0..1 uri Uri that defines the Software that delivers the accident ID. for example https://mysoftware.ch/accidentDB/123456
..... value S 1..1 string The value that is unique
.... identifier:disability S 0..1 Identifier disability identifiers
..... use 0..0 usual | official | temp | secondary | old (If known)
..... type S 1..1 CodeableConcept Description of identifier
...... coding S 1..1 Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
Fixed Value: https://mednet.swiss/fhir/CodeSystem/mni-identifierType
....... code S 1..1 code Symbol in syntax defined by the system
Fixed Value: disability-id
....... display S 0..1 string Representation defined by the system
Fixed Value: disability identifier
..... system S 0..1 uri Uri that defines the Software that delivers the disability ID. for example https://mysoftware.ch/disabilityDB/123456
..... value S 1..1 string The value that is unique
.... identifier:militaryIncident S 0..1 Identifier militaryIncident identifiers
..... use 0..0 usual | official | temp | secondary | old (If known)
..... type S 1..1 CodeableConcept Description of identifier
...... coding S 1..1 Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
Fixed Value: https://mednet.swiss/fhir/CodeSystem/mni-identifierType
....... code S 1..1 code Symbol in syntax defined by the system
Fixed Value: militaryIncident-id
....... display S 0..1 string Representation defined by the system
Fixed Value: military incident identifier
..... system S 0..1 uri Uri that defines the Software that delivers the militaryIncident ID. for example https://mysoftware.ch/militaryIncidentDB/123456
..... value S 1..1 string The value that is unique
... status S 1..1 code Fixed value:active. Only active claim data are usefull
Fixed Value: active
... type S 1..1 CodeableConcept 1 (Ambulant/Ambulatoire/Outpatient) | 3 (stationär/Hospitalisé/Inpatient) | 9 (unbekannt/Inconnu/Unknown)
Binding: BFS Medizinische Statistik - 20 1.3.V01 - Behandlungsart / Type de prise en charge / Genere di trattamento (required)
... use S 1..1 code Fixed value:claim
Fixed Value: claim
... patient S 1..1 Reference(MedNet Interface (MNI) - Patient) Link to the patient concerned by the claim
... created S 1..1 dateTime The date or dateTime the claim has been created
... provider S 1..1 Reference(MedNet Interface (MNI) - PractitionerRole) The mednet practitioner responsible for the claim
... priority S 1..1 CodeableConcept stat (Immediately in real time) | normal (With best effort) | deferred (Later, when possible)
... insurance S 1..* BackboneElement Patient insurance information
.... modifierExtension 0..0 Extension
.... sequence S 1..1 positiveInt The sequence element in Claim.insurance is used to indicate the order of insurance coverage priority. It defines which insurance is primary, secondary, tertiary, etc., in situations where a patient has multiple active insurance policies. sequence = 1 it is the primary insurance
.... focal S 1..1 boolean indicates which insurance coverage is currently responsible for adjudicating (processing and paying) the claim
.... coverage S 1..1 Reference(MedNet Interface (MNI) - Coverage) Insurance information
... accident S 0..1 BackboneElement Details of the event
.... modifierExtension 0..0 Extension
.... date S 1..1 date When the incident occurred
... item S 0..* BackboneElement Product or service provided
.... modifierExtension 0..0 Extension
.... sequence S 1..1 positiveInt unique line number to each item (service or product) listed in the claim
.... category S 1..1 CodeableConcept Fixed category : TARDOC
..... Slices for coding 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:system, value:code
...... coding:TARDOC S 1..1 Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
Fixed Value: http://forum-datenaustausch.ch/tariff
....... code S 1..1 code Symbol in syntax defined by the system
Fixed Value: 007
....... display S 0..1 string Representation defined by the system
Fixed Value: TARDOC
.... productOrService S 1..1 CodeableConcept The tariff position
..... coding S 0..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
Fixed Value: http://forum-datenaustausch.ch/tariff/TMA
...... code S 1..1 code The tariff position code
...... display S 0..1 string The tariff position corresponding text

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Claim.type Base required BFS Medizinische Statistik - 20 1.3.V01 - Behandlungsart / Type de prise en charge / Genere di trattamento 📦3.3.0 CH Term v3.3

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim 0..* Claim MedNet Interface (MNI) - Claim
... id Σ 0..1 id The id is unique within the space of all resources of the same type on the same server It can be any combination of upper- or lower-case ASCII letters 'A'..'Z', and 'a'..'z', numerals ('0'..'9'), '-' and '.' with a length limit of 64 characters. (This might be an integer, an un-prefixed OID, UUID or any other identifier pattern that meets these constraints.)
... meta Σ 0..1 Meta Metadata about the resource
... 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
... Slices for identifier S 0..* Identifier Business Identifier for claim
Slice: Unordered, Open by value:system, value:type.coding.system, value:type.coding.code
.... identifier:accident S 0..1 Identifier accident identifiers
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... type SΣ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ 1..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: https://mednet.swiss/fhir/CodeSystem/mni-identifierType
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: accident-id
....... display SΣ 0..1 string Representation defined by the system
Fixed Value: accident identifier
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... system SΣ 0..1 uri Uri that defines the Software that delivers the accident ID. for example https://mysoftware.ch/accidentDB/123456
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 1..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:disability S 0..1 Identifier disability identifiers
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... type SΣ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ 1..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: https://mednet.swiss/fhir/CodeSystem/mni-identifierType
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: disability-id
....... display SΣ 0..1 string Representation defined by the system
Fixed Value: disability identifier
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... system SΣ 0..1 uri Uri that defines the Software that delivers the disability ID. for example https://mysoftware.ch/disabilityDB/123456
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 1..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:militaryIncident S 0..1 Identifier militaryIncident identifiers
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... type SΣ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ 1..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: https://mednet.swiss/fhir/CodeSystem/mni-identifierType
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: militaryIncident-id
....... display SΣ 0..1 string Representation defined by the system
Fixed Value: military incident identifier
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... system SΣ 0..1 uri Uri that defines the Software that delivers the militaryIncident ID. for example https://mysoftware.ch/militaryIncidentDB/123456
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 1..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code Fixed value:active. Only active claim data are usefull
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Fixed Value: active
... type SΣ 1..1 CodeableConcept 1 (Ambulant/Ambulatoire/Outpatient) | 3 (stationär/Hospitalisé/Inpatient) | 9 (unbekannt/Inconnu/Unknown)
Binding: BFS Medizinische Statistik - 20 1.3.V01 - Behandlungsart / Type de prise en charge / Genere di trattamento (required)
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code Fixed value:claim
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Fixed Value: claim
... patient SΣ 1..1 Reference(MedNet Interface (MNI) - Patient) Link to the patient concerned by the claim
... billablePeriod Σ 0..1 Period Relevant time frame for the claim
... created SΣ 1..1 dateTime The date or dateTime the claim has been created
... enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
... insurer Σ 0..1 Reference(Organization) Target
... provider SΣ 1..1 Reference(MedNet Interface (MNI) - PractitionerRole) The mednet practitioner responsible for the claim
... priority SΣ 1..1 CodeableConcept stat (Immediately in real time) | normal (With best effort) | deferred (Later, when possible)
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
... fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... related 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 0..1 Reference(Claim) Reference to the related claim
.... relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
.... reference 0..1 Identifier File or case reference
... prescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products
... originalPrescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller
... payee 0..1 BackboneElement Recipient of benefits payable
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
.... party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference
... referral 0..1 Reference(ServiceRequest) Treatment referral
... facility 0..1 Reference(Location) Servicing facility
... careTeam 0..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Order of care team
.... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
.... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
... supportingInfo 0..* BackboneElement Supporting information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Information instance identifier
.... category 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
.... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
.... timing[x] 0..1 When it occurred
..... timingDate date
..... timingPeriod Period
.... value[x] 0..1 Data to be provided
..... valueBoolean boolean
..... valueString string
..... valueQuantity Quantity
..... valueAttachment Attachment
..... valueReference Reference(Resource)
.... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
... diagnosis 0..* BackboneElement Pertinent diagnosis information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Diagnosis instance identifier
.... diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosisCodeableConcept CodeableConcept
..... diagnosisReference Reference(Condition)
.... type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
.... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
.... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
.... udi 0..* Reference(Device) Unique device identifier
... insurance SΣ 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... sequence SΣ 1..1 positiveInt The sequence element in Claim.insurance is used to indicate the order of insurance coverage priority. It defines which insurance is primary, secondary, tertiary, etc., in situations where a patient has multiple active insurance policies. sequence = 1 it is the primary insurance
.... focal SΣ 1..1 boolean indicates which insurance coverage is currently responsible for adjudicating (processing and paying) the claim
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage SΣ 1..1 Reference(MedNet Interface (MNI) - Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef 0..* string Prior authorization reference number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... accident S 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... date S 1..1 date When the incident occurred
.... type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
.... location[x] 0..1 Where the event occurred
..... locationAddress Address
..... locationReference Reference(Location)
... item S 0..* BackboneElement Product or service provided
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... sequence S 1..1 positiveInt unique line number to each item (service or product) listed in the claim
.... careTeamSequence 0..* positiveInt Applicable careTeam members
.... diagnosisSequence 0..* positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence 0..* positiveInt Applicable exception and supporting information
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category S 1..1 CodeableConcept Fixed category : TARDOC
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Open by value:system, value:code
...... coding:TARDOC SΣ 1..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://forum-datenaustausch.ch/tariff
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: 007
....... display SΣ 0..1 string Representation defined by the system
Fixed Value: TARDOC
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text Σ 0..1 string Plain text representation of the concept
.... productOrService S 1..1 CodeableConcept The tariff position
Binding: USCLSCodes (example): Allowable service and product codes.
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 0..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://forum-datenaustausch.ch/tariff/TMA
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code The tariff position code
...... display SΣ 0..1 string The tariff position corresponding text
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text Σ 0..1 string Plain text representation of the concept
.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... udi 0..* Reference(Device) Unique device identifier
.... bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
.... encounter 0..* Reference(Encounter) Encounters related to this billed item
.... detail 0..* BackboneElement Product or service provided
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Item instance identifier
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
..... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... udi 0..* Reference(Device) Unique device identifier
..... subDetail 0..* BackboneElement Product or service provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 positiveInt Item instance identifier
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
...... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... udi 0..* Reference(Device) Unique device identifier
... total 0..1 Money Total claim cost

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Claim.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Claim.identifier:accident.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Claim.identifier:disability.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Claim.identifier:militaryIncident.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Claim.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Claim.type Base required BFS Medizinische Statistik - 20 1.3.V01 - Behandlungsart / Type de prise en charge / Genere di trattamento 📦3.3.0 CH Term v3.3
Claim.subType Base example Example Claim SubType Codes 📍4.0.1 FHIR Std.
Claim.use Base required Use 📍4.0.1 FHIR Std.
Claim.priority Base example Process Priority Codes 📍4.0.1 FHIR Std.
Claim.fundsReserve Base example FundsReserve 📍4.0.1 FHIR Std.
Claim.related.relationship Base example Example Related Claim Relationship Codes 📍4.0.1 FHIR Std.
Claim.payee.type Base example PayeeType 📍4.0.1 FHIR Std.
Claim.careTeam.role Base example Claim Care Team Role Codes 📍4.0.1 FHIR Std.
Claim.careTeam.qualification Base example Example Provider Qualification Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo.​category Base example Claim Information Category Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo.​code Base example Exception Codes 📍4.0.1 FHIR Std.
Claim.supportingInfo.​reason Base example Missing Tooth Reason Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.diagnosis[x] Base example ICD-10 Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.type Base example Example Diagnosis Type Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.onAdmission Base example Example Diagnosis on Admission Codes 📍4.0.1 FHIR Std.
Claim.diagnosis.packageCode Base example Example Diagnosis Related Group Codes 📍4.0.1 FHIR Std.
Claim.procedure.type Base example Example Procedure Type Codes 📍4.0.1 FHIR Std.
Claim.procedure.procedure[x] Base example ICD-10 Procedure Codes 📍4.0.1 FHIR Std.
Claim.accident.type Base extensible ActIncidentCode 📦3.0.0 THO v7.0
Claim.item.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item.location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
Claim.item.bodySite Base example Oral Site Codes 📍4.0.1 FHIR Std.
Claim.item.subSite Base example Surface Codes 📍4.0.1 FHIR Std.
Claim.item.detail.revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item.detail.category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item.detail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item.detail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item.detail.programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​revenue Base example Example Revenue Center Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​category Base example Benefit Category Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
Claim.item.detail.subDetail.​programCode Base example Example Program Reason Codes 📍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 Claim

Summary

Mandatory: 0 element(22 nested mandatory elements)
Must-Support: 50 elements
Fixed: 15 elements
Prohibited: 8 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element 3 is sliced based on the values of Claim.identifier
  • The element 2 is sliced based on the values of Claim.item.category.coding

 

Other representations of profile: CSV, Excel, Schematron