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This page is part of the FHIR Specification (v3.0.2: STU 3). The current version which supercedes this version is 5.0.0 . For a full list Continuous Integration Build of available versions, see FHIR (will be incorrect/inconsistent at times).
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13.6 Resource Claim - Content

Responsible Owner: Financial Management icon Work Group Maturity Level : 2   Trial Use Security Category : Patient Compartments : Device , Encounter , Group , Patient , Practitioner , RelatedPerson

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

13.6.1 Scope and Usage

The Claim is used by providers and payors, payers, insurers, to exchange the financial information, and supporting clinical information, regarding the provision of healthcare health care services with payors an payers and for reporting to regulatory bodies and firms which provide data analytics. The primary uses of this resource is to support eClaims, the exchange of information relating to the proposed or actual provision of healthcare-related goods and services for patients to their benefit payors, payers, insurers and national health programs, for treatment payment planning and reimbursement.

The Claim resource is a "request" resource from a FHIR workflow perspective - see Workflow Request.

The Claim resource may be interpreted differently depending on its intended use (and the Claim.use element contains the code to support: indicate):

  • Claims claim - where the provision of goods and services is complete and reimbursement adjudication under a plan and payment is sought.
  • Pre-Authorization preauthorization - where the provision of goods and services is proposed and either authorization and/or the reservation of funds is desired.
  • Pre-Determination predetermination - where the provision of goods and services is explored to determine what services may be covered and to what amount. Essentially a 'what if' claim.

The Claim.type code system provides oral, pharmacy, vision, professional and institutional claim types. Claim types supported are influenced by the requirements of the implementing jurisdiction. The valueset is extensible to accommodate other types of claims as required by the jurisdiction.

The Claim also supports:

  • Up to a 3 tier 3-tier hierarchy of Goods, products, and Services, to support simple to complex billing. billing, see 3-Tier Line Item Hierarchy .
  • Multiple insurance programs arranged in a Coordination of Benefit sequence to enable exchange with primary, secondary, tertiary etc. insurance coverages.
  • Assignment of benefit - the benefit may be requested to be directed to the subscriber, the provider or another party.

Mapping to other Claim specifications: Mappings are currently maintained by the Financial Management Work Group to UB04 and CMS1500 and are available at https://confluence.hl7.org/display/FM/FHIR+Resource+Development icon. Mappings to other specifications may be made available where IP restrictions permit.

13.6.1.1 Additional Information

Additional information regarding electronic claims content and usage may be found at:

  • Financial Resource Status Lifecycle : how .status is used in the financial resources.
  • Secondary Use of Resources : how resources such as Claim and ExplanationOfBenefit may used for reporting and data exchange for analytics, not just for eClaims exchange between providers and payers.
  • Subrogation : how eClaims may handle patient insurance coverages when another insurer rather than the provider will settle the claim and potentially recover costs against specified coverages.
  • Coordination of Benefit : how eClaims may handle multiple patient insurance coverages.
  • Batches : how eClaims may handle batches of eligibility, claims and responses.
  • Attachments and Supporting Information : how eClaims may handle the provision of supporting information, whether provided by content or reference, within the eClaim resource when submitted to the payer or later in a resource which refers to the subject eClaim resource. This also includes how payers may request additional supporting information from providers.
  • 3-Tier Line Item Hierarchy : 3-tier hierarchy of Goods, products, and Services, to support simple to complex billing.
  • Tax : Tax handling of Goods, products, and Services.

13.6.2 Boundaries and Relationships

The Claim resource is referenced by used to request the adjudication and/or authorization of a set of healthcare-related goods and services for a patient against the patient's insurance coverages, or to request what the adjudication would be for a supplied set of goods or services should they be actually supplied to the patient.

When requesting whether the patient's coverage is inforce, whether it is valid at this or a specified date, or requesting the benefit details or preauthorization requirements associated with a coverage, then CoverageEligibilityRequest should be used instead.

When using the resources for reporting and transferring claims data, which may have originated in some standard other than FHIR, the Claim resource is useful if only the request side of the information exchange is of interest. If, however, both the request and the adjudication information is to be reported then the ExplanationOfBenefit should be used instead.

For reporting out to patients or transferring data to patient centered applications, such as Personal Health Record (PHR) application, the ExplanationOfBenefit should be used instead of the Claim and ClaimResponse resources as those resources may contain provider and payer specific information which is not appropriate for sharing with the patient.

The eClaim domain includes a number of related resources

Claim A suite of goods and services and insurances coverages under which adjudication or authorization is requested.
CoverageEligibilityRequest A request to a payer to: ascertain whether a coverage is in-force at the current or at a specified time; list the table of benefits; determine whether coverage is provided for specified categories or specific services; and whether preauthorization is required, and if so what supporting information would be required.
ClaimResponse A payer's adjudication and/or authorization response to the suite of services provided in a Claim. Typically the ClaimResponse references the Claim but does not duplicate the clinical or financial information provided in the claim.
ExplanationOfBenefit This resource combines the information from the Claim and the ClaimResponse, stripping out any provider or payer proprietary information, into a unified information model suitable for use for: patient reporting; transferring information to a Patient Health Record system; and, supporting complete claim and adjudication information exchange with regulatory and analytics organizations and other parts of the provider's organization.

13.6.3 References to this Resource

13.6.2 13.6.4 Resource Content

Structure

0..1 Type Finer grained complete | proposed Period Creation Funds requested Related file Party to be paid any Type positiveInt boolean Role on Type, classification General class Type timingDate timingPeriod Period Reason associated with Package billing code Procedures Service Is the focal Type of service or product Billing Code Service/Product Service Service Type of service or product Billing Code Service Type of service or product Billing Code Net additional
Name Flags Card. Type Description & Constraints      Filter: Filters doco
. . Claim TU DomainResource Claim, Pre-determination or Pre-authorization

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier 0..* Identifier Business Identifier for claim

... traceNumber 0..* Identifier Number for tracking
Claim number
. . . status ?! Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: Financial Resource Status Codes ( Required )
. . type . statusReason Σ 0..1 string Reason for status change
... type Σ 1..1 CodeableConcept Category or discipline
Example Binding: Claim Type Codes ( Required Extensible )
. . . subType 0..* 0..1 CodeableConcept More granular claim type information
Binding: Example Claim SubType Codes ( Example )
. . . use Σ 0..1 1..1 code claim | exploratory preauthorization | other predetermination
Binding: Use ( Required )
. . . patient subject Σ 0..1 1..1 Reference ( Patient | Group ) The subject recipient(s) of the Products products and Services services
. . . billablePeriod Σ 0..1 Period Relevant time frame for charge submission the claim
. . . created Σ 0..1 1..1 dateTime Resource creation date
. . . enterer 0..1 Reference ( Practitioner | PractitionerRole | Patient | RelatedPerson ) Author of the claim
. . . insurer Σ 0..1 Reference ( Organization ) Target
. . . provider Σ 0..1 Reference ( Practitioner ) Responsible provider organization 0..1 Reference | PractitionerRole ( | Organization ) Party responsible for the claim
Responsible organization
. . . priority Σ 0..1 CodeableConcept Desired processing priority urgency
Binding: Process Priority Codes ( Example Preferred )
. . . fundsReserve 0..1 CodeableConcept For whom to be reserved reserve funds
Binding: Funds Reservation Codes ( Example Preferred )
. . . related 0..* BackboneElement Prior or corollary claims
Related Claims which may be revelant to processing this claimn
. . . . claim 0..1 Reference ( Claim ) Reference to the related claim
. . . . relationship 0..1 CodeableConcept How the reference claim is related
Binding: Example Related Claim Relationship Codes ( Example )
. . . . reference 0..1 Identifier File or case reference
. . . prescription 0..1 Reference ( DeviceRequest | MedicationRequest | ServiceRequest | VisionPrescription ) Prescription authorizing services or and products
. . . originalPrescription 0..1 Reference ( DeviceRequest | MedicationRequest | ServiceRequest | VisionPrescription ) Original prescription if superceded superseded by fulfiller
. . . payee 0..1 BackboneElement Recipient of benefits payable
. . . . type 1..1 CodeableConcept Category of party: Subscriber, Provider, other recipient
Binding: Claim Payee Type Codes ( Example )
. . . resourceType . party 0..1 Coding Reference ( Practitioner organization | patient PractitionerRole | practitioner Organization | relatedperson ClaimPayeeResourceType Patient ( Example | RelatedPerson ) Recipient reference
. . party . referral 0..1 Reference ( Practitioner | Organization | Patient | RelatedPerson ServiceRequest ) Treatment referral
Party to receive the payable
. . . referral encounter 0..1 0..* Reference ( ReferralRequest Encounter ) Encounters associated with the listed treatments

Treatment Referral
. . . facility 0..1 Reference ( Location | Organization ) Servicing Facility facility
. . careTeam . diagnosisRelatedGroup 0..1 CodeableConcept 0..* Package billing code
Binding: Example Diagnosis Related Group Codes ( Example )
. . . event 0..* BackboneElement Event information
Members of the care team
. . . sequence . type 1..1 CodeableConcept Specific event
Binding: Dates Type Codes ( Example )
. . . . when[x] 1..1 Occurance date or period
Number to covey order of careTeam
. . . . provider . whenDateTime dateTime
. . . . . whenPeriod 1..1 Reference Period ( Practitioner
. . . careTeam | Organization ) 0..* BackboneElement Members of the care team

Provider individual or organization
. . . responsible . sequence 1..1 positiveInt 0..1 Order of care team
. . . . provider 1..1 Reference ( Practitioner | PractitionerRole | Organization ) Practitioner or organization
Billing provider
. . . . role 0..1 CodeableConcept Function within the team
Binding: Claim Care Team Role Codes ( Example Preferred )
. . . . qualification specialty 0..1 CodeableConcept Practitioner or Specialization provider specialization
Binding: Example Provider Qualification Codes ( Example )
. . information . supportingInfo 0..* BackboneElement Supporting information
Exceptions, special considerations, the condition, situation, prior or concurrent issues
. . . . sequence 1..1 positiveInt Information instance identifier
. . . . category 1..1 CodeableConcept Classification of the supplied information
Binding: Claim Information Category Codes ( Example Preferred )
. . . . code subCategory 0..1 CodeableConcept Finer-grained classification of the supplied information
Exception Codes Binding: InformationSubCategory ( Example )
. . . timing[x] . code 0..1 When it occurred 0..1 date CodeableConcept Type of information
Binding: Exception Codes ( Example )
. . . . value[x] timing[x] 0..1 When it occurred
Additional Data or supporting information
. . . . valueString . timingDateTime string dateTime
. . . . . valueQuantity timingPeriod Quantity Period
. . . . valueAttachment . timingTiming Attachment Timing
. . . valueReference . value[x] 0..1 Reference ( Any * ) Data to be provided
. . . . reason 0..1 CodeableConcept Explanation for the information
Binding: Missing Tooth Reason Codes ( Example )
. . . diagnosis 0..* BackboneElement Pertinent diagnosis information
List of Diagnosis
. . . . sequence 1..1 positiveInt Diagnosis instance identifier
Number to covey order of diagnosis
. . . . diagnosis[x] 1..1 Patient's diagnosis Nature of illness or problem
Binding: ICD-10 Codes ( Example )
. . . . . diagnosisCodeableConcept CodeableConcept
. . . . . diagnosisReference Reference ( Condition )
. . . . type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: Example Diagnosis Type Codes ( Example Preferred )

. . . . packageCode onAdmission 0..1 CodeableConcept Present on admission
Binding: Example Diagnosis Related Group on Admission Codes ( Example Preferred )
. . . procedure 0..* BackboneElement Clinical procedures performed

. . . . sequence 1..1 positiveInt Procedure instance identifier
. . . . type 0..* CodeableConcept Category of Procedure sequence for reference
Binding: Example Procedure Type Codes ( Preferred )

. . . . date 0..1 dateTime When the procedure was performed
. . . . procedure[x] 1..1 Patient's list of procedures performed Specific clinical procedure
Binding: ICD-10 Procedure Codes ( Example )
. . . . . procedureCodeableConcept CodeableConcept
. . . . . procedureReference Reference ( Procedure )
. . . . udi 0..* Reference ( Device ) Unique device identifier

... insurance Σ 0..* BackboneElement Patient insurance information
Insurance or medical plan
. . . . sequence Σ 1..1 positiveInt Insurance instance identifier
. . . . focal Σ 1..1 boolean Coverage to be used for adjudication
. . . . identifier 0..1 Identifier Pre-assigned Claim number
.... coverage Σ 1..1 Reference ( Coverage ) Insurance information
. . . . businessArrangement 0..1 string Additional provider contract number
Business agreement
. . . . preAuthRef 0..* string Prior authorization reference number
Pre-Authorization/Determination Reference
. . . . claimResponse 0..1 Reference ( ClaimResponse ) Adjudication results
. . . accident 0..1 BackboneElement Details about an accident of the event
. . . . date 1..1 date When the accident incident occurred see information codes see information codes
. . . . type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode icon ( Required Extensible )
. . . . location[x] 0..1 Where the event occurred
Accident Place
. . . . . locationAddress Address
. . . . . locationReference Reference ( Location )
. . employmentImpacted . patientPaid 0..1 Period Money Paid by the patient
Period unable to work
. . hospitalization . item 0..* BackboneElement 0..1 Product or service provided

Period
. . . . sequence 1..1 positiveInt Item instance identifier
Period in hospital
. . . item . traceNumber 0..* BackboneElement Identifier Number for tracking
Goods and Services
. . . sequence . subject 1..1 0..1 positiveInt Reference ( Patient | Group ) The recipient of the products and services
Service instance
. . . . careTeamLinkId careTeamSequence 0..* positiveInt Applicable careTeam members

. . . diagnosisLinkId . diagnosisSequence 0..* positiveInt Applicable diagnoses

. . . . procedureLinkId procedureSequence 0..* positiveInt Applicable procedures

. . . informationLinkId . informationSequence 0..* positiveInt Applicable exception and supporting information

. . . . revenue 0..1 CodeableConcept Revenue or cost center code
Binding: Example Revenue Center Codes ( Example )
. . . . category 0..1 CodeableConcept Benefit classification
Binding: Benefit SubCategory Category Codes ( Example )
. . . . service productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLS Codes ( Example )
. . . modifier . productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLS Codes ( Example )
.... request 0..* Reference ( DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | VisionPrescription ) Request or Referral for Service

.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: Modifier type Codes ( Example )

. . . . programCode 0..* CodeableConcept Program specific reason for item inclusion the product or service is provided under
Binding: Example Program Reason Codes ( Example )

. . . . serviced[x] 0..1 Date or dates of Service service or product delivery
. . . . . servicedDate date
. . . . . servicedPeriod Period
. . . . location[x] 0..1 Place of service or where product was supplied
Binding: Example Service Place Codes ( Example )
. . . . . locationCodeableConcept CodeableConcept
. . . . . locationAddress Address
. . . . . locationReference Reference ( Location )
. . . . quantity patientPaid 0..1 Money Paid by the patient
.... quantity 0..1 SimpleQuantity Count of Products products or Services services
. . . . unitPrice 0..1 Money Fee, charge or cost per point item
. . . . factor 0..1 decimal Price scaling factor
. . . . net tax 0..1 Money Total tax
. . . . net 0..1 Money Total item cost
. . . . udi 0..* Reference ( Device ) Unique Device Identifier device identifier

. . . . bodySite 0..* BackboneElement 0..1 Anatomical location

CodeableConcept
. . . . . site Service 1..* CodeableReference ( BodyStructure ) Location
Binding: Oral Site Codes ( Example )

. . . . . subSite 0..* CodeableConcept Sub-location
Binding: Surface Codes ( Example )

. . . . encounter 0..* Reference ( Encounter ) Encounters related to this billed item associated with the listed treatments

. . . . detail 0..* BackboneElement Product or service provided
Additional items
. . . . . sequence 1..1 positiveInt Item instance identifier
. . . . . traceNumber 0..* Identifier Number for tracking

. . . . . revenue 0..1 CodeableConcept Revenue or cost center code
Binding: Example Revenue Center Codes ( Example )
. . . . . category 0..1 CodeableConcept Benefit classification
Binding: Benefit SubCategory Category Codes ( Example )
. . . . . service productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLS Codes ( Example )
. . . . . productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLS Codes ( Example )
. . . . . modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: Modifier type Codes ( Example )

. . . . . programCode 0..* CodeableConcept Program specific reason for item inclusion the product or service is provided under
Binding: Example Program Reason Codes ( Example )

. . . . . quantity patientPaid 0..1 Money Paid by the patient
..... quantity 0..1 SimpleQuantity Count of Products products or Services services
. . . . . unitPrice 0..1 Money Fee, charge or cost per point item
. . . . . factor 0..1 decimal Price scaling factor
. . . . . net tax 0..1 Money Total tax
. . . . . net 0..1 Money Total additional item cost
. . . . . udi 0..* Reference ( Device ) Unique Device Identifier device identifier

. . . . . subDetail 0..* BackboneElement Product or service provided
Additional items
. . . . . . sequence 1..1 positiveInt Item instance identifier
. . . . . . traceNumber 0..* Identifier Number for tracking

. . . . . . revenue 0..1 CodeableConcept Revenue or cost center code
Binding: Example Revenue Center Codes ( Example )
. . . . . . category 0..1 CodeableConcept Benefit classification
Binding: Benefit SubCategory Category Codes ( Example )
. . . . . . service productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLS Codes ( Example )
. . . . . . productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLS Codes ( Example )
. . . . . . modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: Modifier type Codes ( Example )

. . . . . . programCode 0..* CodeableConcept Program specific reason for item inclusion the product or service is provided under
Binding: Example Program Reason Codes ( Example )

. . . . . . quantity patientPaid 0..1 Money Paid by the patient
...... quantity 0..1 SimpleQuantity Count of Products products or Services services
. . . . . . unitPrice 0..1 Money Fee, charge or cost per point item
. . . . . . factor 0..1 decimal Price scaling factor
. . . . . . net tax 0..1 Money Total tax
. . . . . . net 0..1 Money Total item cost
. . . . . . udi 0..* Reference ( Device ) Unique Device Identifier device identifier

. . . total 0..1 Money Total claim cost

doco Documentation for this format icon

See the Extensions for this resource

UML Diagram ( Legend )

Claim ( DomainResource ) The business A unique identifier assigned to this claim identifier : Identifier [0..*] Trace number for tracking purposes. May be defined at the instance: claim number, pre-determination jurisdiction level or pre-authorization number between trading partners identifier traceNumber : Identifier [0..*] The status of the resource instance (this element modifies the meaning of other elements) status : code [0..1] [1..1] « A code specifying the state of the resource instance. null (Strength=Required) Financial Resource Status FinancialResourceStatusCodes ! » Used to indicate why the status has changed statusReason : string [0..1] The category of claim, eg, e.g. oral, pharmacy, vision, insitutional, institutional, professional type : CodeableConcept [0..1] [1..1] « The type or discipline-style of the claim (Strength=Required) null (Strength=Extensible) Example Claim Type ! ClaimTypeCodes + » A finer grained suite of claim subtype type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service. In the US the BillType service subType : CodeableConcept [0..*] [0..1] « A more granular claim typecode null (Strength=Example) Example Claim SubType ExampleClaimSubTypeCodes ?? » Complete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination) A code to indicate whether the nature of the request is: Claim - A request to an Insurer to adjudicate the supplied charges for health care goods and services under the identified policy and to pay the determined Benefit amount, if any; Preauthorization - A request to an Insurer to adjudicate the supplied proposed future charges for health care goods and services under the identified policy and to approve the services and provide the expected benefit amounts and potentially to reserve funds to pay the benefits when Claims for the indicated services are later submitted; or, Pre-determination - A request to an Insurer to adjudicate the supplied 'what if' charges for health care goods and services under the identified policy and report back what the Benefit payable would be had the services actually been provided use : code [0..1] [1..1] « Complete, proposed, exploratory, other null (Strength=Required) Use ! » Patient Resource The party/group to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought patient subject : Reference [0..1] [1..1] « Patient | Group » The billable period for which charges are being submitted billablePeriod : Period [0..1] The date when the enclosed suite of services were performed or completed this resource was created created : dateTime [0..1] [1..1] Person Individual who created the invoice/claim/pre-determination claim, predetermination or pre-authorization preauthorization enterer : Reference [0..1] « Practitioner | PractitionerRole | Patient | RelatedPerson » The Insurer who is target of the request insurer : Reference [0..1] « Organization » The provider which is responsible for the bill, claim pre-determination, pre-authorization claim, predetermination or preauthorization provider : Reference [0..1] « Practitioner | PractitionerRole | The organization which is responsible for the bill, claim pre-determination, pre-authorization organization : Reference [0..1] Organization » Immediate (STAT), best effort (NORMAL), The provider-required urgency of processing the request. Typical values include: stat, normal, deferred (DEFER) priority : CodeableConcept [0..1] « The timeliness with which processing is required: STAT, normal, Deferred (Strength=Example) null (Strength=Preferred) Process Priority ProcessPriorityCodes ?? ? » In the case of a Pre-Determination/Pre-Authorization the provider may request that A code to indicate whether and for whom funds in the amount of the expected Benefit are to be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested future claims fundsReserve : CodeableConcept [0..1] « For whom funds are to be reserved: (Patient, Provider, None). (Strength=Example) null (Strength=Preferred) Funds Reservation FundsReservationCodes ?? ? » Prescription is the document/authorization given to support the dispensing of Pharmacy or Vision claim author for them to provide products and services for which consideration (reimbursement) is sought. Could be a RX for medications, an 'order' for oxygen or wheelchair or physiotherapy treatments prescription : Reference [0..1] « DeviceRequest | MedicationRequest | ServiceRequest | VisionPrescription » Original prescription which has been superceded superseded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription' products originalPrescription : Reference [0..1] « DeviceRequest | MedicationRequest | ServiceRequest | VisionPrescription » The referral resource which lists information received by the date, practitioner, reason and other claim author, it is not to be used when the author generates a referral for a patient. A copy of that referral may be provided as supporting information information. Some insurers require proof of referral to pay for services or to pay specialist rates for services referral : Reference [0..1] ReferralRequest « ServiceRequest » Healthcare encounters related to this claim encounter : Reference [0..*] « Encounter » Facility where the services were provided facility : Reference [0..1] « Location | Organization » The start A package billing code or bundle code used to group products and optional end dates of when the patient was precluded from working due services to the treatable condition(s) a particular health condition (such as heart attack) which is based on a predetermined grouping code system employmentImpacted diagnosisRelatedGroup : Period CodeableConcept [0..1] « null (Strength=Example) ExampleDiagnosisRelatedGroupC... ?? » The start and optional end dates of when amount paid by the patient was confined patient, in total at the claim claim level or specifically for the item and detail level, to a treatment center the provider for goods and services hospitalization patientPaid : Period Money [0..1] The total value of the all the items in the claim total : Money [0..1] RelatedClaim Other claims which are related Reference to this claim such as prior claim versions or for a related services claim claim : Reference [0..1] « Claim » For example prior or umbrella A code to convey how the claims are related relationship : CodeableConcept [0..1] « Relationship of this claim to a related Claim null (Strength=Example) Example Related Claim Relatio... ExampleRelatedClaimRelationsh... ?? » An alternate organizational reference to the case or file to which this particular claim pertains - eg Property/Casualy insurer claim # or Workers Compensation case # reference : Identifier [0..1] Payee Type of Party to be reimbursed: Subscriber, subscriber, provider, other type : CodeableConcept [1..1] « A code for the party to be reimbursed. null (Strength=Example) Claim Payee Type ClaimPayeeTypeCodes ?? » Reference to the individual or organization | patient | practitioner | relatedperson to whom any payment will be made resourceType party : Coding Reference [0..1] « Practitioner | PractitionerRole | Organization | Patient | RelatedPerson » Event The A coded event such as when a service is expected or a card printed type of Claim payee Resource : CodeableConcept [1..1] « null (Strength=Example) ClaimPayeeResourceType DatesTypeCodes ?? » Party A date or period in the past or future indicating when the event occurred or is expectd to be reimbursed: Subscriber, provider, other occur party when[x] : Reference [0..1] Practitioner | Organization DataType | Patient [1..1] « dateTime | RelatedPerson Period » CareTeam Sequence of the careTeam which serves A number to order and provide a link uniquely identify care team entries sequence : positiveInt [1..1] Member of the team who provided the overall product or service provider : Reference [1..1] « Practitioner | Organization PractitionerRole | The party who is billing and responsible for the claimed good or service rendered to the patient responsible : boolean Organization [0..1] » The lead, assisting or supervising practitioner and their discipline if a multidisiplinary multidisciplinary team role : CodeableConcept [0..1] « The role codes for the care team members. (Strength=Example) null (Strength=Preferred) Claim Care Team Role ClaimCareTeamRoleCodes ?? ? » The qualification specialization of the practitioner or provider which is applicable for this service qualification specialty : CodeableConcept [0..1] « Provider professional qualifications null (Strength=Example) Example Provider Qualificatio... ExampleProviderQualificationC... ?? » SpecialCondition SupportingInformation Sequence of the information element which serves A number to provide a link uniquely identify supporting information entries sequence : positiveInt [1..1] The general class of the information supplied: information; exception; accident, employment; onset, etc category : CodeableConcept [1..1] « The valuset used for additional information null (Strength=Preferred) ClaimInformationCategoryCodes ? » A finer classification within the more general category codes. (Strength=Example) Claim Information Category subCategory ?? : CodeableConcept [0..1] « null (Strength=Example) InformationSubCategory?? » System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought which may influence the adjudication code : CodeableConcept [0..1] « The valuset used for additional information codes. null (Strength=Example) Exception ExceptionCodes ?? » The date when or period to which this information refers timing[x] : Type DataType [0..1] date « dateTime | Period | Timing » Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data value[x] : Type * [0..1] string | Quantity | Attachment | Reference ( Any ) For example, provides Provides the reason for: in the additional stay, or missing tooth or any other situation where a reason code is required in addition to the content reason : CodeableConcept [0..1] « Reason codes for the missing teeth null (Strength=Example) Missing Tooth Reason MissingToothReasonCodes ?? » Diagnosis Sequence of diagnosis which serves A number to provide a link uniquely identify diagnosis entries sequence : positiveInt [1..1] The diagnosis nature of illness or problem in a coded form or as a reference to an external defined Condition diagnosis[x] : Type DataType [1..1] « CodeableConcept | Reference ( Condition ); ICD10 Diagnostic codes null (Strength=Example) ICD-10 ICD10Codes ?? » The type of When the Diagnosis, for example: admitting, primary, secondary, discharge condition was observed or the relative ranking type : CodeableConcept [0..*] « The type of the diagnosis: admitting, principal, discharge (Strength=Example) null (Strength=Preferred) Example Diagnosis Type ExampleDiagnosisTypeCodes ?? ? » The package billing code, for example DRG, based on Indication of whether the assigned grouping code system diagnosis was present on admission to a facility packageCode onAdmission : CodeableConcept [0..1] « The DRG codes associated with the diagnosis (Strength=Example) null (Strength=Preferred) Example Diagnosis Related Gro... ExampleDiagnosisOnAdmissionCo... ?? ? » Procedure Sequence of procedures which serves A number to order and provide a link uniquely identify procedure entries sequence : positiveInt [1..1] When the condition was observed or the relative ranking type : CodeableConcept [0..*] « null (Strength=Preferred) ExampleProcedureTypeCodes ? » Date and optionally time the procedure was performed date : dateTime [0..1] The procedure code or reference to a Procedure resource which identifies the clinical intervention performed procedure[x] : Type DataType [1..1] « CodeableConcept | Reference ( Procedure ); ICD10 Procedure codes null (Strength=Example) ICD-10 Procedure ICD10ProcedureCodes ?? » Unique Device Identifiers associated with this line item udi : Reference [0..*] « Device » Insurance Sequence of coverage which serves A number to uniquely identify insurance entries and provide a link and sequence of coverages to convey coordination of benefit order sequence : positiveInt [1..1] A flag to indicate that this Coverage is the focus to be used for adjudication. The Coverage against which the adjudication of this claim is when set to be adjudicated true focal : boolean [1..1] The business identifier to be used when the claim is sent for adjudication against this insurance policy identifier : Identifier [0..1] Reference to the program or plan identification, underwriter or payor insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system coverage : Reference [1..1] « Coverage » The contract number of a A business agreement which describes number established between the terms provider and conditions the insurer for special business processing purposes businessArrangement : string [0..1] A list of references from Reference numbers previously provided by the Insurer insurer to which these the provider to be quoted on subsequent claims containing services pertain or products related to the prior authorization preAuthRef : string [0..*] The Coverages result of the adjudication details of the line items for the Coverage specified in this insurance claimResponse : Reference [0..1] « ClaimResponse » Accident Date of an accident which these event related to the products and services are addressing contained in the claim date : date [1..1] Type The type or context of accident: work, auto, etc the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers type : CodeableConcept [0..1] « Type of accident: work place, auto, etc. (Strength=Required) null (Strength=Extensible) ActIncidentCode ! + » Accident Place The physical location of the accident event location[x] : Type DataType [0..1] « Address | Reference ( Location ) » Item A service line number to uniquely identify item entries sequence : positiveInt [1..1] CareTeam applicable Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners traceNumber : Identifier [0..*] The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for facast reimbursement is sought subject : Reference [0..1] « Patient | Group » CareTeam members related to this service or product line careTeamLinkId careTeamSequence : positiveInt [0..*] Diagnosis applicable for this service or product line diagnosisLinkId diagnosisSequence : positiveInt [0..*] Procedures applicable for this service or product line procedureLinkId procedureSequence : positiveInt [0..*] Exceptions, special conditions and supporting information pplicable applicable for this service or product line informationLinkId informationSequence : positiveInt [0..*] The type of reveneu revenue or cost center providing the product and/or service revenue : CodeableConcept [0..1] « Codes for the revenue or cost centers supplying the service and/or products. null (Strength=Example) Example Revenue Center ExampleRevenueCenterCodes ?? » Health Care Service Type Codes Code to identify the classification general type of service or benefits under which products and services are provided category : CodeableConcept [0..1] « Benefit subcategories such as: oral-basic, major, glasses null (Strength=Example) Benefit SubCategory BenefitCategoryCodes ?? » If this When the value is an actual service or product line, ie. not a Group, then use group code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,RXNorm,ACHI,CCI). If a grouping item then use this item collects a group set of related item details, otherwise this contains the product, service, drug or other billing code to indicate for the type item. This element may be the start of thing being grouped eg. 'glasses' a range of .productOrService codes used in conjunction with .productOrServiceEnd or 'compound' it may be a solo element where .productOrServiceEnd is not used service productOrService : CodeableConcept [0..1] « Allowable service and product codes null (Strength=Example) USCLS USCLSCodes ?? » Item typification This contains the end of a range of product, service, drug or modifiers codes, eg other billing codes for Oral whether the treatment item. This element is cosmetic or associated with TMJ, or for medical whether not used when the treatment was outside .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the clinic or out start of office hours the range. Typically this value may be used only with preauthorizations and not with claims modifier productOrServiceEnd : CodeableConcept [0..1] « null (Strength=Example) USCLSCodes ?? » Request or Referral for Goods or Service to be rendered request : Reference [0..*] « DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | VisionPrescription » Item type typification or modifiers codes, eg codes to convey additional context for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost product or stolen. service modifier : CodeableConcept [0..*] « null (Strength=Example) Modifier type ModifierTypeCodes ?? » For programs which require reason codes for the inclusion or covering of this billed item under Identifies the program or sub-program under which this may be recovered programCode : CodeableConcept [0..*] « Program specific reason codes null (Strength=Example) Example Program Reason ExampleProgramReasonCodes ?? » The date or dates when the enclosed suite of services were service or product was supplied, performed or completed serviced[x] : Type DataType [0..1] « date | Period » Where the product or service was provided location[x] : Type DataType [0..1] « CodeableConcept | Address | Reference ( Location ); Place of service: pharmacy,school, prison, etc. null (Strength=Example) Example Service Place ExampleServicePlaceCodes ?? » The amount paid by the patient, in total at the claim claim level or specifically for the item and detail level, to the provider for goods and services patientPaid : Money [0..1] The number of repetitions of a service or product quantity : Quantity ( SimpleQuantity ) [0..1] If the item is not a node group then this is the fee for the product or service, otherwise this is the total of the fees for the children details of the group unitPrice : Money [0..1] A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount factor : decimal [0..1] The quantity times the unit price total of taxes applicable for an addittional service or this product or charge. For example, service tax : Money [0..1] The total amount claimed for the formula: unit Quantity * group (if a grouper) or the line item. Net = unit Price (Cost per Point) price * factor Number quantity * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied net : Money [0..1] List of Unique Device Identifiers associated with this line item udi : Reference [0..*] « Device » Healthcare encounters related to this claim encounter : Reference [0..*] « Encounter » BodySite Physical service site on the patient (limb, tooth, etc) etc.) bodySite site : CodeableConcept CodeableReference [0..1] [1..*] « BodyStructure ; The code for the teeth, quadrant, sextant and arch null (Strength=Example) Oral Site OralSiteCodes ?? » A region or surface of the site, eg. bodySite, e.g. limb region or tooth surface(s) subSite : CodeableConcept [0..*] « The code for the tooth surface and surface combinations null (Strength=Example) Surface SurfaceCodes ?? » A billed item may include goods or services provided in multiple encounters encounter : Reference [0..*] Encounter Detail A service line number to uniquely identify item entries sequence : positiveInt [1..1] Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners traceNumber : Identifier [0..*] The type of reveneu revenue or cost center providing the product and/or service revenue : CodeableConcept [0..1] « Codes for the revenue or cost centers supplying the service and/or products. null (Strength=Example) Example Revenue Center ExampleRevenueCenterCodes ?? » Health Care Service Type Codes Code to identify the classification general type of service or benefits under which products and services are provided category : CodeableConcept [0..1] « Benefit subcategories such as: oral-basic, major, glasses null (Strength=Example) Benefit SubCategory BenefitCategoryCodes ?? » If this When the value is an actual service or product line, ie. not a Group, then use group code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use this item collects a group set of related item details, otherwise this contains the product, service, drug or other billing code to indicate for the type item. This element may be the start of thing being grouped eg. 'glasses' a range of .productOrService codes used in conjunction with .productOrServiceEnd or 'compound' it may be a solo element where .productOrServiceEnd is not used service productOrService : CodeableConcept [0..1] « Allowable service and product codes null (Strength=Example) USCLS USCLSCodes ?? » Item typification This contains the end of a range of product, service, drug or modifiers codes, eg other billing codes for Oral whether the treatment item. This element is cosmetic or associated with TMJ, or for medical whether not used when the treatment was outside .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the clinic or out start of office hours the range. Typically this value may be used only with preauthorizations and not with claims modifier productOrServiceEnd : CodeableConcept [0..*] [0..1] « null (Strength=Example) USCLSCodes ?? » Item type typification or modifiers codes, eg codes to convey additional context for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost product or stolen. service modifier : CodeableConcept [0..*] « null (Strength=Example) Modifier type ModifierTypeCodes ?? » For programs which require reson codes for the inclusion, covering, of this billed item under Identifies the program or sub-program under which this may be recovered programCode : CodeableConcept [0..*] « Program specific reason codes null (Strength=Example) Example Program Reason ExampleProgramReasonCodes ?? » The amount paid by the patient, in total at the claim claim level or specifically for the item and detail level, to the provider for goods and services patientPaid : Money [0..1] The number of repetitions of a service or product quantity : Quantity ( SimpleQuantity ) [0..1] If the item is not a node group then this is the fee for the product or service, otherwise this is the total of the fees for the children details of the group unitPrice : Money [0..1] A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount factor : decimal [0..1] The quantity times the unit price total of taxes applicable for an addittional service or this product or charge. For example, service tax : Money [0..1] The total amount claimed for the formula: unit Quantity * group (if a grouper) or the line item.detail. Net = unit Price (Cost per Point) price * factor Number quantity * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied net : Money [0..1] List of Unique Device Identifiers associated with this line item udi : Reference [0..*] « Device » SubDetail A service line number to uniquely identify item entries sequence : positiveInt [1..1] Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners traceNumber : Identifier [0..*] The type of reveneu revenue or cost center providing the product and/or service revenue : CodeableConcept [0..1] « Codes for the revenue or cost centers supplying the service and/or products. null (Strength=Example) Example Revenue Center ExampleRevenueCenterCodes ?? » Health Care Service Type Codes Code to identify the classification general type of service or benefits under which products and services are provided category : CodeableConcept [0..1] « Benefit subcategories such as: oral-basic, major, glasses null (Strength=Example) Benefit SubCategory BenefitCategoryCodes ?? » A When the value is a group code to indicate then this item collects a set of related item details, otherwise this contains the Professional Service product, service, drug or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI) other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used service productOrService : CodeableConcept [0..1] « Allowable service and product codes null (Strength=Example) USCLS USCLSCodes ?? » Item typification This contains the end of a range of product, service, drug or modifiers codes, eg other billing codes for Oral whether the treatment item. This element is cosmetic or associated with TMJ, or for medical whether not used when the treatment was outside .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the clinic or out start of office hours the range. Typically this value may be used only with preauthorizations and not with claims modifier productOrServiceEnd : CodeableConcept [0..*] [0..1] « null (Strength=Example) USCLSCodes ?? » Item type typification or modifiers codes, eg codes to convey additional context for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost product or stolen. service modifier : CodeableConcept [0..*] « null (Strength=Example) Modifier type ModifierTypeCodes ?? » For programs which require reson codes for the inclusion, covering, of this billed item under Identifies the program or sub-program under which this may be recovered programCode : CodeableConcept [0..*] « Program specific reason codes null (Strength=Example) Example Program Reason ExampleProgramReasonCodes ?? » The amount paid by the patient, in total at the claim claim level or specifically for the item and detail level, to the provider for goods and services patientPaid : Money [0..1] The number of repetitions of a service or product quantity : Quantity ( SimpleQuantity ) [0..1] The If the item is not a group then this is the fee for an addittional service or the product or charge service, otherwise this is the total of the fees for the details of the group unitPrice : Money [0..1] A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount factor : decimal [0..1] The quantity times the unit price total of taxes applicable for an addittional service or this product or charge. For example, the formula: unit Quantity * service tax : Money [0..1] The total amount claimed for line item.detail.subDetail. Net = unit Price (Cost per Point) price * factor Number quantity * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied net : Money [0..1] List of Unique Device Identifiers associated with this line item udi : Reference [0..*] « Device » Other claims which are related to this claim such as prior claim versions submissions or claims for related services or for the same event related [0..*] The party to be reimbursed for cost of the products and services according to the terms of the policy payee [0..1] Information code for an event with a corresponding date or period event [0..*] The members of the team who provided the overall service as well as their role and whether responsible products and qualifications services careTeam [0..*] Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required issues information supportingInfo [0..*] List of patient diagnosis for which care is sought Information about diagnoses relevant to the claim items diagnosis [0..*] Ordered list of patient procedures Procedures performed on the patient relevant to support the adjudication billing items with the claim procedure [0..*] Financial instrument by which payment information instruments for reimbursement for the health care products and services specified on the claim insurance [0..*] An Details of an accident which resulted in injuries which required the need for healthcare products and services listed in the claim accident [0..1] Third tier Physical location where the service is performed or applies bodySite [0..*] A claim detail line. Either a simple (a product or service) or a 'group' of goods and services sub-details which are simple items subDetail [0..*] Second tier A claim detail line. Either a simple (a product or service) or a 'group' of goods and services sub-details which are simple items detail [0..*] First tier A claim line. Either a simple product or service or a 'group' of goods and services details which can each be a simple items or groups of sub-details item [0..*]

XML Template 

<

<Claim xmlns="http://hl7.org/fhir"> doco

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <</identifier>
 <
 <</type>
 <</subType>
 <
 <</patient>
 <</billablePeriod>
 <
 <</enterer>

 <identifier><!-- 0..* Identifier Business Identifier for claim --></identifier>
 <traceNumber><!-- 0..* Identifier Number for tracking --></traceNumber>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <statusReason value="[string]"/><!-- 0..1 Reason for status change -->
 <type><!-- 1..1 CodeableConcept Category or discipline --></type>
 <subType><!-- 0..1 CodeableConcept More granular claim type --></subType>
 <use value="[code]"/><!-- 1..1 claim | preauthorization | predetermination -->
 <subject><!-- 1..1 Reference(Group|Patient) The recipient(s) of the products and services --></subject>
 <billablePeriod><!-- 0..1 Period Relevant time frame for the claim --></billablePeriod>
 <created value="[dateTime]"/><!-- 1..1 Resource creation date -->
 <enterer><!-- 0..1 Reference(Patient|Practitioner|PractitionerRole|RelatedPerson) Author of the claim --></enterer>

 <insurer><!-- 0..1 Reference(Organization) Target --></insurer>
 <</provider>
 <</organization>
 <</priority>
 <</fundsReserve>
 <
  <</claim>
  <</relationship>
  <</reference>

 <provider><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Party responsible for the claim --></provider>
 <priority><!-- 0..1 CodeableConcept Desired processing urgency --></priority>
 <fundsReserve><!-- 0..1 CodeableConcept For whom to reserve funds --></fundsReserve>
 <related>  <!-- 0..* Prior or corollary claims -->
  <claim><!-- 0..1 Reference(Claim) Reference to the related claim --></claim>
  <relationship><!-- 0..1 CodeableConcept How the reference claim is related --></relationship>
  <reference><!-- 0..1 Identifier File or case reference --></reference>

 </related>
 <</prescription>
 <</originalPrescription>
 <
  <</type>
  <</resourceType>
  <</party>

 <prescription><!-- 0..1 Reference(DeviceRequest|MedicationRequest|ServiceRequest|
   VisionPrescription) Prescription authorizing services and products --></prescription>

 <originalPrescription><!-- 0..1 Reference(DeviceRequest|MedicationRequest|
   ServiceRequest|VisionPrescription) Original prescription if superseded by fulfiller --></originalPrescription>

 <payee>  <!-- 0..1 Recipient of benefits payable -->
  <type><!-- 1..1 CodeableConcept Category of recipient --></type>
  <party><!-- 0..1 Reference(Organization|Patient|Practitioner|PractitionerRole|
    RelatedPerson) Recipient reference --></party>
 </payee>
 <</referral>
 <</facility>
 <
  <
  <</provider>
  <
  <</role>
  <</qualification>

 <referral><!-- 0..1 Reference(ServiceRequest) Treatment referral --></referral>
 <encounter><!-- 0..* Reference(Encounter) Encounters associated with the listed treatments --></encounter>
 <facility><!-- 0..1 Reference(Location|Organization) Servicing facility --></facility>
 <diagnosisRelatedGroup><!-- 0..1 CodeableConcept Package billing code --></diagnosisRelatedGroup>
 <event>  <!-- 0..* Event information -->
  <type><!-- 1..1 CodeableConcept Specific event --></type>
  <when[x]><!-- 1..1 dateTime|Period Occurance date or period --></when[x]>
 </event>
 <careTeam>  <!-- 0..* Members of the care team -->
  <sequence value="[positiveInt]"/><!-- 1..1 Order of care team -->
  <provider><!-- 1..1 Reference(Organization|Practitioner|PractitionerRole) Practitioner or organization --></provider>
  <role><!-- 0..1 CodeableConcept Function within the team --></role>
  <specialty><!-- 0..1 CodeableConcept Practitioner or provider specialization --></specialty>

 </careTeam>
 <
  <
  <</category>
  <</code>
  <</timing[x]>
  <</value[x]>
  <</reason>
 </information>
 <
  <
  <</diagnosis[x]>
  <</type>
  <</packageCode>

 <supportingInfo>  <!-- 0..* Supporting information -->
  <sequence value="[positiveInt]"/><!-- 1..1 Information instance identifier -->
  <category><!-- 1..1 CodeableConcept Classification of the supplied information --></category>
  <subCategory><!-- 0..1 CodeableConcept Finer-grained classification of the supplied information --></subCategory>
  <code><!-- 0..1 CodeableConcept Type of information --></code>
  <timing[x]><!-- 0..1 dateTime|Period|Timing When it occurred --></timing[x]>
  <value[x]><!-- 0..1 * Data to be provided --></value[x]>
  <reason><!-- 0..1 CodeableConcept Explanation for the information --></reason>
 </supportingInfo>
 <diagnosis>  <!-- 0..* Pertinent diagnosis information -->
  <sequence value="[positiveInt]"/><!-- 1..1 Diagnosis instance identifier -->
  <diagnosis[x]><!-- 1..1 CodeableConcept|Reference(Condition) Nature of illness or problem --></diagnosis[x]>
  <type><!-- 0..* CodeableConcept Timing or nature of the diagnosis --></type>
  <onAdmission><!-- 0..1 CodeableConcept Present on admission --></onAdmission>

 </diagnosis>
 <
  <
  <
  <</procedure[x]>

 <procedure>  <!-- 0..* Clinical procedures performed -->
  <sequence value="[positiveInt]"/><!-- 1..1 Procedure instance identifier -->
  <type><!-- 0..* CodeableConcept Category of Procedure --></type>
  <date value="[dateTime]"/><!-- 0..1 When the procedure was performed -->
  <procedure[x]><!-- 1..1 CodeableConcept|Reference(Procedure) Specific clinical procedure --></procedure[x]>
  <udi><!-- 0..* Reference(Device) Unique device identifier --></udi>

 </procedure>
 <
  <
  <
  <</coverage>
  <
  <
  <</claimResponse>

 <insurance>  <!-- 0..* Patient insurance information -->
  <sequence value="[positiveInt]"/><!-- 1..1 Insurance instance identifier -->
  <focal value="[boolean]"/><!-- 1..1 Coverage to be used for adjudication -->
  <identifier><!-- 0..1 Identifier Pre-assigned Claim number --></identifier>
  <coverage><!-- 1..1 Reference(Coverage) Insurance information --></coverage>
  <businessArrangement value="[string]"/><!-- 0..1 Additional provider contract number -->
  <preAuthRef value="[string]"/><!-- 0..* Prior authorization reference number -->
  <claimResponse><!-- 0..1 Reference(ClaimResponse) Adjudication results --></claimResponse>

 </insurance>
 <
  <When the accident occurred
see information codes
see information codes
  <</type>
  <</location[x]>

 <accident>  <!-- 0..1 Details of the event -->
  <date value="[date]"/><!-- 1..1 When the incident occurred -->
  <type><!-- 0..1 CodeableConcept The nature of the accident icon --></type>
  <location[x]><!-- 0..1 Address|Reference(Location) Where the event occurred --></location[x]>

 </accident>
 <</employmentImpacted>
 <</hospitalization>
 <
  <
  <
  <
  <
  <
  <</revenue>
  <</category>
  <</service>
  <</modifier>
  <</programCode>
  <</serviced[x]>
  <</location[x]>
  <</quantity>
  <</unitPrice>
  <
  <</net>
  <</udi>
  <</bodySite>
  <</subSite>
  <</encounter>
  <
   <
   <</revenue>
   <</category>
   <</service>
   <</modifier>
   <</programCode>
   <</quantity>
   <</unitPrice>
   <
   <</net>
   <</udi>
   <
    <
    <</revenue>
    <</category>
    <</service>
    <</modifier>
    <</programCode>
    <</quantity>
    <</unitPrice>
    <
    <</net>
    <</udi>

 <patientPaid><!-- 0..1 Money Paid by the patient --></patientPaid>
 <item>  <!-- 0..* Product or service provided -->
  <sequence value="[positiveInt]"/><!-- 1..1 Item instance identifier -->
  <traceNumber><!-- 0..* Identifier Number for tracking --></traceNumber>
  <subject><!-- 0..1 Reference(Group|Patient) The recipient of the products and services --></subject>
  <careTeamSequence value="[positiveInt]"/><!-- 0..* Applicable careTeam members -->
  <diagnosisSequence value="[positiveInt]"/><!-- 0..* Applicable diagnoses -->
  <procedureSequence value="[positiveInt]"/><!-- 0..* Applicable procedures -->
  <informationSequence value="[positiveInt]"/><!-- 0..* Applicable exception and supporting information -->
  <revenue><!-- 0..1 CodeableConcept Revenue or cost center code --></revenue>
  <category><!-- 0..1 CodeableConcept Benefit classification --></category>
  <productOrService><!-- 0..1 CodeableConcept Billing, service, product, or drug code --></productOrService>
  <productOrServiceEnd><!-- 0..1 CodeableConcept End of a range of codes --></productOrServiceEnd>
  <request><!-- 0..* Reference(DeviceRequest|MedicationRequest|NutritionOrder|
    ServiceRequest|VisionPrescription) Request or Referral for Service --></request>

  <modifier><!-- 0..* CodeableConcept Product or service billing modifiers --></modifier>
  <programCode><!-- 0..* CodeableConcept Program the product or service is provided under --></programCode>
  <serviced[x]><!-- 0..1 date|Period Date or dates of service or product delivery --></serviced[x]>
  <location[x]><!-- 0..1 CodeableConcept|Address|Reference(Location) Place of service or where product was supplied --></location[x]>
  <patientPaid><!-- 0..1 Money Paid by the patient --></patientPaid>
  <quantity><!-- 0..1 Quantity(SimpleQuantity) Count of products or services --></quantity>
  <unitPrice><!-- 0..1 Money Fee, charge or cost per item --></unitPrice>
  <factor value="[decimal]"/><!-- 0..1 Price scaling factor -->
  <tax><!-- 0..1 Money Total tax --></tax>
  <net><!-- 0..1 Money Total item cost --></net>
  <udi><!-- 0..* Reference(Device) Unique device identifier --></udi>
  <bodySite>  <!-- 0..* Anatomical location -->
   <site><!-- 1..* CodeableReference(BodyStructure) Location --></site>
   <subSite><!-- 0..* CodeableConcept Sub-location --></subSite>
  </bodySite>
  <encounter><!-- 0..* Reference(Encounter) Encounters associated with the listed treatments --></encounter>
  <detail>  <!-- 0..* Product or service provided -->
   <sequence value="[positiveInt]"/><!-- 1..1 Item instance identifier -->
   <traceNumber><!-- 0..* Identifier Number for tracking --></traceNumber>
   <revenue><!-- 0..1 CodeableConcept Revenue or cost center code --></revenue>
   <category><!-- 0..1 CodeableConcept Benefit classification --></category>
   <productOrService><!-- 0..1 CodeableConcept Billing, service, product, or drug code --></productOrService>
   <productOrServiceEnd><!-- 0..1 CodeableConcept End of a range of codes --></productOrServiceEnd>
   <modifier><!-- 0..* CodeableConcept Service/Product billing modifiers --></modifier>
   <programCode><!-- 0..* CodeableConcept Program the product or service is provided under --></programCode>
   <patientPaid><!-- 0..1 Money Paid by the patient --></patientPaid>
   <quantity><!-- 0..1 Quantity(SimpleQuantity) Count of products or services --></quantity>
   <unitPrice><!-- 0..1 Money Fee, charge or cost per item --></unitPrice>
   <factor value="[decimal]"/><!-- 0..1 Price scaling factor -->
   <tax><!-- 0..1 Money Total tax --></tax>
   <net><!-- 0..1 Money Total item cost --></net>
   <udi><!-- 0..* Reference(Device) Unique device identifier --></udi>
   <subDetail>  <!-- 0..* Product or service provided -->
    <sequence value="[positiveInt]"/><!-- 1..1 Item instance identifier -->
    <traceNumber><!-- 0..* Identifier Number for tracking --></traceNumber>
    <revenue><!-- 0..1 CodeableConcept Revenue or cost center code --></revenue>
    <category><!-- 0..1 CodeableConcept Benefit classification --></category>
    <productOrService><!-- 0..1 CodeableConcept Billing, service, product, or drug code --></productOrService>
    <productOrServiceEnd><!-- 0..1 CodeableConcept End of a range of codes --></productOrServiceEnd>
    <modifier><!-- 0..* CodeableConcept Service/Product billing modifiers --></modifier>
    <programCode><!-- 0..* CodeableConcept Program the product or service is provided under --></programCode>
    <patientPaid><!-- 0..1 Money Paid by the patient --></patientPaid>
    <quantity><!-- 0..1 Quantity(SimpleQuantity) Count of products or services --></quantity>
    <unitPrice><!-- 0..1 Money Fee, charge or cost per item --></unitPrice>
    <factor value="[decimal]"/><!-- 0..1 Price scaling factor -->
    <tax><!-- 0..1 Money Total tax --></tax>
    <net><!-- 0..1 Money Total item cost --></net>
    <udi><!-- 0..* Reference(Device) Unique device identifier --></udi>

   </subDetail>
  </detail>
 </item>
 <</total>

 <total><!-- 0..1 Money Total claim cost --></total>

</Claim>

JSON Template 

{doco
  "resourceType" : "",

  "resourceType" : "Claim",

  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
    "
    "
    "

  "identifier" : [{ Identifier }], // Business Identifier for claim
  "traceNumber" : [{ Identifier }], // Number for tracking
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  "statusReason" : "<string>", // Reason for status change
  "type" : { CodeableConcept }, // R!  Category or discipline
  "subType" : { CodeableConcept }, // More granular claim type
  "use" : "<code>", // R!  claim | preauthorization | predetermination
  "subject" : { Reference(Group|Patient) }, // R!  The recipient(s) of the products and services
  "billablePeriod" : { Period }, // Relevant time frame for the claim
  "created" : "<dateTime>", // R!  Resource creation date
  "enterer" : { Reference(Patient|Practitioner|PractitionerRole|RelatedPerson) }, // Author of the claim
  "insurer" : { Reference(Organization) }, // Target
  "provider" : { Reference(Organization|Practitioner|PractitionerRole) }, // Party responsible for the claim
  "priority" : { CodeableConcept }, // Desired processing urgency
  "fundsReserve" : { CodeableConcept }, // For whom to reserve funds
  "related" : [{ // Prior or corollary claims
    "claim" : { Reference(Claim) }, // Reference to the related claim
    "relationship" : { CodeableConcept }, // How the reference claim is related
    "reference" : { Identifier } // File or case reference

  }],
  "
  "
  "
    "
    "
    "

  "prescription" : { Reference(DeviceRequest|MedicationRequest|ServiceRequest|
   VisionPrescription) }, // Prescription authorizing services and products

  "originalPrescription" : { Reference(DeviceRequest|MedicationRequest|
   ServiceRequest|VisionPrescription) }, // Original prescription if superseded by fulfiller

  "payee" : { // Recipient of benefits payable
    "type" : { CodeableConcept }, // R!  Category of recipient
    "party" : { Reference(Organization|Patient|Practitioner|PractitionerRole|
    RelatedPerson) } // Recipient reference
  },
  "
  "
  "
    "
    "
    "
    "
    "

  "referral" : { Reference(ServiceRequest) }, // Treatment referral
  "encounter" : [{ Reference(Encounter) }], // Encounters associated with the listed treatments
  "facility" : { Reference(Location|Organization) }, // Servicing facility
  "diagnosisRelatedGroup" : { CodeableConcept }, // Package billing code
  "event" : [{ // Event information
    "type" : { CodeableConcept }, // R!  Specific event
    // when[x]: Occurance date or period. One of these 2:

    "whenDateTime" : "<dateTime>",
    "whenPeriod" : { Period }

  }],
  "
    "
    "
    "
    
    ">",
    " },
    
    ">",
    " },
    " },
    " },
    "

  "careTeam" : [{ // Members of the care team
    "sequence" : "<positiveInt>", // R!  Order of care team
    "provider" : { Reference(Organization|Practitioner|PractitionerRole) }, // R!  Practitioner or organization
    "role" : { CodeableConcept }, // Function within the team
    "specialty" : { CodeableConcept } // Practitioner or provider specialization

  }],
  "
    "
    
    " },
    " },
    "
    "

  "supportingInfo" : [{ // Supporting information
    "sequence" : "<positiveInt>", // R!  Information instance identifier
    "category" : { CodeableConcept }, // R!  Classification of the supplied information
    "subCategory" : { CodeableConcept }, // Finer-grained classification of the supplied information
    "code" : { CodeableConcept }, // Type of information
    // timing[x]: When it occurred. One of these 3:

    "timingDateTime" : "<dateTime>",
    "timingPeriod" : { Period },
    "timingTiming" : { Timing },
    // value[x]: Data to be provided. One of these 55:

    "valueBase64Binary" : "<base64Binary>",
    "valueBoolean" : <boolean>,
    "valueCanonical" : "<canonical>",
    "valueCode" : "<code>",
    "valueDate" : "<date>",
    "valueDateTime" : "<dateTime>",
    "valueDecimal" : <decimal>,
    "valueId" : "<id>",
    "valueInstant" : "<instant>",
    "valueInteger" : <integer>,
    "valueInteger64" : "<integer64>",
    "valueMarkdown" : "<markdown>",
    "valueOid" : "<oid>",
    "valuePositiveInt" : "<positiveInt>",
    "valueString" : "<string>",
    "valueTime" : "<time>",
    "valueUnsignedInt" : "<unsignedInt>",
    "valueUri" : "<uri>",
    "valueUrl" : "<url>",
    "valueUuid" : "<uuid>",
    "valueAddress" : { Address },
    "valueAge" : { Age },
    "valueAnnotation" : { Annotation },
    "valueAttachment" : { Attachment },
    "valueCodeableConcept" : { CodeableConcept },
    "valueCodeableReference" : { CodeableReference },
    "valueCoding" : { Coding },
    "valueContactPoint" : { ContactPoint },
    "valueCount" : { Count },
    "valueDistance" : { Distance },
    "valueDuration" : { Duration },
    "valueHumanName" : { HumanName },
    "valueIdentifier" : { Identifier },
    "valueMoney" : { Money },
    "valuePeriod" : { Period },
    "valueQuantity" : { Quantity },
    "valueRange" : { Range },
    "valueRatio" : { Ratio },
    "valueRatioRange" : { RatioRange },
    "valueReference" : { Reference },
    "valueSampledData" : { SampledData },
    "valueSignature" : { Signature },
    "valueTiming" : { Timing },
    "valueContactDetail" : { ContactDetail },
    "valueDataRequirement" : { DataRequirement },
    "valueExpression" : { Expression },
    "valueParameterDefinition" : { ParameterDefinition },
    "valueRelatedArtifact" : { RelatedArtifact },
    "valueTriggerDefinition" : { TriggerDefinition },
    "valueUsageContext" : { UsageContext },
    "valueAvailability" : { Availability },
    "valueExtendedContactDetail" : { ExtendedContactDetail },
    "valueVirtualServiceDetail" : { VirtualServiceDetail },
    "valueDosage" : { Dosage },
    "valueMeta" : { Meta },
    "reason" : { CodeableConcept } // Explanation for the information

  }],
  "
    "
    "
    
    " }
    " }

  "diagnosis" : [{ // Pertinent diagnosis information
    "sequence" : "<positiveInt>", // R!  Diagnosis instance identifier
    // diagnosis[x]: Nature of illness or problem. One of these 2:

    "diagnosisCodeableConcept" : { CodeableConcept },
    "diagnosisReference" : { Reference(Condition) },
    "type" : [{ CodeableConcept }], // Timing or nature of the diagnosis
    "onAdmission" : { CodeableConcept } // Present on admission

  }],
  "
    "
    "
    "
    "
    "
    "

  "procedure" : [{ // Clinical procedures performed
    "sequence" : "<positiveInt>", // R!  Procedure instance identifier
    "type" : [{ CodeableConcept }], // Category of Procedure
    "date" : "<dateTime>", // When the procedure was performed
    // procedure[x]: Specific clinical procedure. One of these 2:

    "procedureCodeableConcept" : { CodeableConcept },
    "procedureReference" : { Reference(Procedure) },
    "udi" : [{ Reference(Device) }] // Unique device identifier

  }],
  "
    "When the accident occurred
see information codes
see information codes
    "
    
    " }
    " }

  "insurance" : [{ // Patient insurance information
    "sequence" : "<positiveInt>", // R!  Insurance instance identifier
    "focal" : <boolean>, // R!  Coverage to be used for adjudication
    "identifier" : { Identifier }, // Pre-assigned Claim number
    "coverage" : { Reference(Coverage) }, // R!  Insurance information
    "businessArrangement" : "<string>", // Additional provider contract number
    "preAuthRef" : ["<string>"], // Prior authorization reference number
    "claimResponse" : { Reference(ClaimResponse) } // Adjudication results
  }],
  "accident" : { // Details of the event
    "date" : "<date>", // R!  When the incident occurred
    "type" : { CodeableConcept }, // The nature of the accident icon
    // location[x]: Where the event occurred. One of these 2:

    "locationAddress" : { Address },
    "locationReference" : { Reference(Location) }

  },
  "
  "
  "
    "
    "
    "
    "
    "
    "
    "
    "
    "
    "
    
    ">",
    " },
    
    " },
    " },
    " },
    "
    "
    "
    "
    "
    "
    "
    "
    "
      "
      "
      "
      "
      "
      "
      "
      "
      "
      "
      "
      "
        "
        "
        "
        "
        "
        "
        "
        "
        "
        "
        "

  "patientPaid" : { Money }, // Paid by the patient
  "item" : [{ // Product or service provided
    "sequence" : "<positiveInt>", // R!  Item instance identifier
    "traceNumber" : [{ Identifier }], // Number for tracking
    "subject" : { Reference(Group|Patient) }, // The recipient of the products and services
    "careTeamSequence" : ["<positiveInt>"], // Applicable careTeam members
    "diagnosisSequence" : ["<positiveInt>"], // Applicable diagnoses
    "procedureSequence" : ["<positiveInt>"], // Applicable procedures
    "informationSequence" : ["<positiveInt>"], // Applicable exception and supporting information
    "revenue" : { CodeableConcept }, // Revenue or cost center code
    "category" : { CodeableConcept }, // Benefit classification
    "productOrService" : { CodeableConcept }, // Billing, service, product, or drug code
    "productOrServiceEnd" : { CodeableConcept }, // End of a range of codes
    "request" : [{ Reference(DeviceRequest|MedicationRequest|NutritionOrder|
    ServiceRequest|VisionPrescription) }], // Request or Referral for Service

    "modifier" : [{ CodeableConcept }], // Product or service billing modifiers
    "programCode" : [{ CodeableConcept }], // Program the product or service is provided under
    // serviced[x]: Date or dates of service or product delivery. One of these 2:

    "servicedDate" : "<date>",
    "servicedPeriod" : { Period },
    // location[x]: Place of service or where product was supplied. One of these 3:

    "locationCodeableConcept" : { CodeableConcept },
    "locationAddress" : { Address },
    "locationReference" : { Reference(Location) },
    "patientPaid" : { Money }, // Paid by the patient
    "quantity" : { Quantity(SimpleQuantity) }, // Count of products or services
    "unitPrice" : { Money }, // Fee, charge or cost per item
    "factor" : <decimal>, // Price scaling factor
    "tax" : { Money }, // Total tax
    "net" : { Money }, // Total item cost
    "udi" : [{ Reference(Device) }], // Unique device identifier
    "bodySite" : [{ // Anatomical location
      "site" : [{ CodeableReference(BodyStructure) }], // R!  Location
      "subSite" : [{ CodeableConcept }] // Sub-location
    }],
    "encounter" : [{ Reference(Encounter) }], // Encounters associated with the listed treatments
    "detail" : [{ // Product or service provided
      "sequence" : "<positiveInt>", // R!  Item instance identifier
      "traceNumber" : [{ Identifier }], // Number for tracking
      "revenue" : { CodeableConcept }, // Revenue or cost center code
      "category" : { CodeableConcept }, // Benefit classification
      "productOrService" : { CodeableConcept }, // Billing, service, product, or drug code
      "productOrServiceEnd" : { CodeableConcept }, // End of a range of codes
      "modifier" : [{ CodeableConcept }], // Service/Product billing modifiers
      "programCode" : [{ CodeableConcept }], // Program the product or service is provided under
      "patientPaid" : { Money }, // Paid by the patient
      "quantity" : { Quantity(SimpleQuantity) }, // Count of products or services
      "unitPrice" : { Money }, // Fee, charge or cost per item
      "factor" : <decimal>, // Price scaling factor
      "tax" : { Money }, // Total tax
      "net" : { Money }, // Total item cost
      "udi" : [{ Reference(Device) }], // Unique device identifier
      "subDetail" : [{ // Product or service provided
        "sequence" : "<positiveInt>", // R!  Item instance identifier
        "traceNumber" : [{ Identifier }], // Number for tracking
        "revenue" : { CodeableConcept }, // Revenue or cost center code
        "category" : { CodeableConcept }, // Benefit classification
        "productOrService" : { CodeableConcept }, // Billing, service, product, or drug code
        "productOrServiceEnd" : { CodeableConcept }, // End of a range of codes
        "modifier" : [{ CodeableConcept }], // Service/Product billing modifiers
        "programCode" : [{ CodeableConcept }], // Program the product or service is provided under
        "patientPaid" : { Money }, // Paid by the patient
        "quantity" : { Quantity(SimpleQuantity) }, // Count of products or services
        "unitPrice" : { Money }, // Fee, charge or cost per item
        "factor" : <decimal>, // Price scaling factor
        "tax" : { Money }, // Total tax
        "net" : { Money }, // Total item cost
        "udi" : [{ Reference(Device) }] // Unique device identifier

      }]
    }]
  }],
  "

  "total" : { Money } // Total claim cost

}

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:;

[ a fhir:Claim;

  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from 
  # from 
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
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  fhir:
    fhir:
    fhir:
    fhir:
  ], ...;
  fhir:
  fhir:
  fhir:
    fhir:
    fhir:
    fhir:
  ];
  fhir:
  fhir:
  fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
  ], ...;
  fhir:
    fhir:
    fhir:
    fhir:
    # . One of these 2
      fhir: ]
      fhir: ]
    # . One of these 4
      fhir: ]
      fhir: ]
      fhir: ]
      fhir:) ]
    fhir:
  ], ...;
  fhir:
    fhir:
    # . One of these 2
      fhir: ]
      fhir:) ]
    fhir:
    fhir:
  ], ...;
  fhir:
    fhir:
    fhir:
    # . One of these 2
      fhir: ]
      fhir:) ]
  ], ...;
  fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
  ], ...;
  fhir:
    fhir:When the accident occurred
see information codes
see information codes
    fhir:
    # . One of these 2
      fhir: ]
      fhir:) ]
  ];
  fhir:
  fhir:
  fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    # . One of these 2
      fhir: ]
      fhir: ]
    # . One of these 3
      fhir: ]
      fhir: ]
      fhir:) ]
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
      fhir:
      fhir:
      fhir:
      fhir:
      fhir:
      fhir:
      fhir:
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      fhir:
      fhir:
      fhir:
      fhir:
        fhir:
        fhir:
        fhir:
        fhir:
        fhir:
        fhir:
        fhir:
        fhir:
        fhir:
        fhir:
        fhir:
      ], ...;
    ], ...;
  ], ...;
  fhir:

  # from Resource: fhir:id, fhir:meta, fhir:implicitRules, and fhir:language
  # from DomainResource: fhir:text, fhir:contained, fhir:extension, and fhir:modifierExtension
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Business Identifier for claim
  fhir:traceNumber  ( [ Identifier ] ... ) ; # 0..* Number for tracking
  fhir:status [ code ] ; # 1..1 active | cancelled | draft | entered-in-error
  fhir:statusReason [ string ] ; # 0..1 Reason for status change
  fhir:type [ CodeableConcept ] ; # 1..1 Category or discipline
  fhir:subType [ CodeableConcept ] ; # 0..1 More granular claim type
  fhir:use [ code ] ; # 1..1 claim | preauthorization | predetermination
  fhir:subject [ Reference(Group|Patient) ] ; # 1..1 The recipient(s) of the products and services
  fhir:billablePeriod [ Period ] ; # 0..1 Relevant time frame for the claim
  fhir:created [ dateTime ] ; # 1..1 Resource creation date
  fhir:enterer [ Reference(Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 0..1 Author of the claim
  fhir:insurer [ Reference(Organization) ] ; # 0..1 Target
  fhir:provider [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Party responsible for the claim
  fhir:priority [ CodeableConcept ] ; # 0..1 Desired processing urgency
  fhir:fundsReserve [ CodeableConcept ] ; # 0..1 For whom to reserve funds
  fhir:related ( [ # 0..* Prior or corollary claims
    fhir:claim [ Reference(Claim) ] ; # 0..1 Reference to the related claim
    fhir:relationship [ CodeableConcept ] ; # 0..1 How the reference claim is related
    fhir:reference [ Identifier ] ; # 0..1 File or case reference
  ] ... ) ;
  fhir:prescription [ Reference(DeviceRequest|MedicationRequest|ServiceRequest|VisionPrescription) ] ; # 0..1 Prescription authorizing services and products
  fhir:originalPrescription [ Reference(DeviceRequest|MedicationRequest|ServiceRequest|VisionPrescription) ] ; # 0..1 Original prescription if superseded by fulfiller
  fhir:payee [ # 0..1 Recipient of benefits payable
    fhir:type [ CodeableConcept ] ; # 1..1 Category of recipient
    fhir:party [ Reference(Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 0..1 Recipient reference
  ] ;
  fhir:referral [ Reference(ServiceRequest) ] ; # 0..1 Treatment referral
  fhir:encounter  ( [ Reference(Encounter) ] ... ) ; # 0..* Encounters associated with the listed treatments
  fhir:facility [ Reference(Location|Organization) ] ; # 0..1 Servicing facility
  fhir:diagnosisRelatedGroup [ CodeableConcept ] ; # 0..1 Package billing code
  fhir:event ( [ # 0..* Event information
    fhir:type [ CodeableConcept ] ; # 1..1 Specific event
    # when[x] : 1..1 Occurance date or period. One of these 2
      fhir:when [  a fhir:DateTime ; dateTime ]
      fhir:when [  a fhir:Period ; Period ]
  ] ... ) ;
  fhir:careTeam ( [ # 0..* Members of the care team
    fhir:sequence [ positiveInt ] ; # 1..1 Order of care team
    fhir:provider [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 1..1 Practitioner or organization
    fhir:role [ CodeableConcept ] ; # 0..1 Function within the team
    fhir:specialty [ CodeableConcept ] ; # 0..1 Practitioner or provider specialization
  ] ... ) ;
  fhir:supportingInfo ( [ # 0..* Supporting information
    fhir:sequence [ positiveInt ] ; # 1..1 Information instance identifier
    fhir:category [ CodeableConcept ] ; # 1..1 Classification of the supplied information
    fhir:subCategory [ CodeableConcept ] ; # 0..1 Finer-grained classification of the supplied information
    fhir:code [ CodeableConcept ] ; # 0..1 Type of information
    # timing[x] : 0..1 When it occurred. One of these 3
      fhir:timing [  a fhir:DateTime ; dateTime ]
      fhir:timing [  a fhir:Period ; Period ]
      fhir:timing [  a fhir:Timing ; Timing ]
    # value[x] : 0..1 Data to be provided. One of these 55
      fhir:value [  a fhir:Base64Binary ; base64Binary ]
      fhir:value [  a fhir:Boolean ; boolean ]
      fhir:value [  a fhir:Canonical ; canonical ]
      fhir:value [  a fhir:Code ; code ]
      fhir:value [  a fhir:Date ; date ]
      fhir:value [  a fhir:DateTime ; dateTime ]
      fhir:value [  a fhir:Decimal ; decimal ]
      fhir:value [  a fhir:Id ; id ]
      fhir:value [  a fhir:Instant ; instant ]
      fhir:value [  a fhir:Integer ; integer ]
      fhir:value [  a fhir:Integer64 ; integer64 ]
      fhir:value [  a fhir:Markdown ; markdown ]
      fhir:value [  a fhir:Oid ; oid ]
      fhir:value [  a fhir:PositiveInt ; positiveInt ]
      fhir:value [  a fhir:String ; string ]
      fhir:value [  a fhir:Time ; time ]
      fhir:value [  a fhir:UnsignedInt ; unsignedInt ]
      fhir:value [  a fhir:Uri ; uri ]
      fhir:value [  a fhir:Url ; url ]
      fhir:value [  a fhir:Uuid ; uuid ]
      fhir:value [  a fhir:Address ; Address ]
      fhir:value [  a fhir:Age ; Age ]
      fhir:value [  a fhir:Annotation ; Annotation ]
      fhir:value [  a fhir:Attachment ; Attachment ]
      fhir:value [  a fhir:CodeableConcept ; CodeableConcept ]
      fhir:value [  a fhir:CodeableReference ; CodeableReference ]
      fhir:value [  a fhir:Coding ; Coding ]
      fhir:value [  a fhir:ContactPoint ; ContactPoint ]
      fhir:value [  a fhir:Count ; Count ]
      fhir:value [  a fhir:Distance ; Distance ]
      fhir:value [  a fhir:Duration ; Duration ]
      fhir:value [  a fhir:HumanName ; HumanName ]
      fhir:value [  a fhir:Identifier ; Identifier ]
      fhir:value [  a fhir:Money ; Money ]
      fhir:value [  a fhir:Period ; Period ]
      fhir:value [  a fhir:Quantity ; Quantity ]
      fhir:value [  a fhir:Range ; Range ]
      fhir:value [  a fhir:Ratio ; Ratio ]
      fhir:value [  a fhir:RatioRange ; RatioRange ]
      fhir:value [  a fhir:Reference ; Reference ]
      fhir:value [  a fhir:SampledData ; SampledData ]
      fhir:value [  a fhir:Signature ; Signature ]
      fhir:value [  a fhir:Timing ; Timing ]
      fhir:value [  a fhir:ContactDetail ; ContactDetail ]
      fhir:value [  a fhir:DataRequirement ; DataRequirement ]
      fhir:value [  a fhir:Expression ; Expression ]
      fhir:value [  a fhir:ParameterDefinition ; ParameterDefinition ]
      fhir:value [  a fhir:RelatedArtifact ; RelatedArtifact ]
      fhir:value [  a fhir:TriggerDefinition ; TriggerDefinition ]
      fhir:value [  a fhir:UsageContext ; UsageContext ]
      fhir:value [  a fhir:Availability ; Availability ]
      fhir:value [  a fhir:ExtendedContactDetail ; ExtendedContactDetail ]
      fhir:value [  a fhir:VirtualServiceDetail ; VirtualServiceDetail ]
      fhir:value [  a fhir:Dosage ; Dosage ]
      fhir:value [  a fhir:Meta ; Meta ]
    fhir:reason [ CodeableConcept ] ; # 0..1 Explanation for the information
  ] ... ) ;
  fhir:diagnosis ( [ # 0..* Pertinent diagnosis information
    fhir:sequence [ positiveInt ] ; # 1..1 Diagnosis instance identifier
    # diagnosis[x] : 1..1 Nature of illness or problem. One of these 2
      fhir:diagnosis [  a fhir:CodeableConcept ; CodeableConcept ]
      fhir:diagnosis [  a fhir:Reference ; Reference(Condition) ]
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* Timing or nature of the diagnosis
    fhir:onAdmission [ CodeableConcept ] ; # 0..1 Present on admission
  ] ... ) ;
  fhir:procedure ( [ # 0..* Clinical procedures performed
    fhir:sequence [ positiveInt ] ; # 1..1 Procedure instance identifier
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* Category of Procedure
    fhir:date [ dateTime ] ; # 0..1 When the procedure was performed
    # procedure[x] : 1..1 Specific clinical procedure. One of these 2
      fhir:procedure [  a fhir:CodeableConcept ; CodeableConcept ]
      fhir:procedure [  a fhir:Reference ; Reference(Procedure) ]
    fhir:udi  ( [ Reference(Device) ] ... ) ; # 0..* Unique device identifier
  ] ... ) ;
  fhir:insurance ( [ # 0..* Patient insurance information
    fhir:sequence [ positiveInt ] ; # 1..1 Insurance instance identifier
    fhir:focal [ boolean ] ; # 1..1 Coverage to be used for adjudication
    fhir:identifier [ Identifier ] ; # 0..1 Pre-assigned Claim number
    fhir:coverage [ Reference(Coverage) ] ; # 1..1 Insurance information
    fhir:businessArrangement [ string ] ; # 0..1 Additional provider contract number
    fhir:preAuthRef  ( [ string ] ... ) ; # 0..* Prior authorization reference number
    fhir:claimResponse [ Reference(ClaimResponse) ] ; # 0..1 Adjudication results
  ] ... ) ;
  fhir:accident [ # 0..1 Details of the event
    fhir:date [ date ] ; # 1..1 When the incident occurred
    fhir:type [ CodeableConcept ] ; # 0..1 The nature of the accident
    # location[x] : 0..1 Where the event occurred. One of these 2
      fhir:location [  a fhir:Address ; Address ]
      fhir:location [  a fhir:Reference ; Reference(Location) ]
  ] ;
  fhir:patientPaid [ Money ] ; # 0..1 Paid by the patient
  fhir:item ( [ # 0..* Product or service provided
    fhir:sequence [ positiveInt ] ; # 1..1 Item instance identifier
    fhir:traceNumber  ( [ Identifier ] ... ) ; # 0..* Number for tracking
    fhir:subject [ Reference(Group|Patient) ] ; # 0..1 The recipient of the products and services
    fhir:careTeamSequence  ( [ positiveInt ] ... ) ; # 0..* Applicable careTeam members
    fhir:diagnosisSequence  ( [ positiveInt ] ... ) ; # 0..* Applicable diagnoses
    fhir:procedureSequence  ( [ positiveInt ] ... ) ; # 0..* Applicable procedures
    fhir:informationSequence  ( [ positiveInt ] ... ) ; # 0..* Applicable exception and supporting information
    fhir:revenue [ CodeableConcept ] ; # 0..1 Revenue or cost center code
    fhir:category [ CodeableConcept ] ; # 0..1 Benefit classification
    fhir:productOrService [ CodeableConcept ] ; # 0..1 Billing, service, product, or drug code
    fhir:productOrServiceEnd [ CodeableConcept ] ; # 0..1 End of a range of codes
    fhir:request  ( [ Reference(DeviceRequest|MedicationRequest|NutritionOrder|ServiceRequest|VisionPrescription) ] ... ) ; # 0..* Request or Referral for Service
    fhir:modifier  ( [ CodeableConcept ] ... ) ; # 0..* Product or service billing modifiers
    fhir:programCode  ( [ CodeableConcept ] ... ) ; # 0..* Program the product or service is provided under
    # serviced[x] : 0..1 Date or dates of service or product delivery. One of these 2
      fhir:serviced [  a fhir:Date ; date ]
      fhir:serviced [  a fhir:Period ; Period ]
    # location[x] : 0..1 Place of service or where product was supplied. One of these 3
      fhir:location [  a fhir:CodeableConcept ; CodeableConcept ]
      fhir:location [  a fhir:Address ; Address ]
      fhir:location [  a fhir:Reference ; Reference(Location) ]
    fhir:patientPaid [ Money ] ; # 0..1 Paid by the patient
    fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 Count of products or services
    fhir:unitPrice [ Money ] ; # 0..1 Fee, charge or cost per item
    fhir:factor [ decimal ] ; # 0..1 Price scaling factor
    fhir:tax [ Money ] ; # 0..1 Total tax
    fhir:net [ Money ] ; # 0..1 Total item cost
    fhir:udi  ( [ Reference(Device) ] ... ) ; # 0..* Unique device identifier
    fhir:bodySite ( [ # 0..* Anatomical location
      fhir:site  ( [ CodeableReference(BodyStructure) ] ... ) ; # 1..* Location
      fhir:subSite  ( [ CodeableConcept ] ... ) ; # 0..* Sub-location
    ] ... ) ;
    fhir:encounter  ( [ Reference(Encounter) ] ... ) ; # 0..* Encounters associated with the listed treatments
    fhir:detail ( [ # 0..* Product or service provided
      fhir:sequence [ positiveInt ] ; # 1..1 Item instance identifier
      fhir:traceNumber  ( [ Identifier ] ... ) ; # 0..* Number for tracking
      fhir:revenue [ CodeableConcept ] ; # 0..1 Revenue or cost center code
      fhir:category [ CodeableConcept ] ; # 0..1 Benefit classification
      fhir:productOrService [ CodeableConcept ] ; # 0..1 Billing, service, product, or drug code
      fhir:productOrServiceEnd [ CodeableConcept ] ; # 0..1 End of a range of codes
      fhir:modifier  ( [ CodeableConcept ] ... ) ; # 0..* Service/Product billing modifiers
      fhir:programCode  ( [ CodeableConcept ] ... ) ; # 0..* Program the product or service is provided under
      fhir:patientPaid [ Money ] ; # 0..1 Paid by the patient
      fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 Count of products or services
      fhir:unitPrice [ Money ] ; # 0..1 Fee, charge or cost per item
      fhir:factor [ decimal ] ; # 0..1 Price scaling factor
      fhir:tax [ Money ] ; # 0..1 Total tax
      fhir:net [ Money ] ; # 0..1 Total item cost
      fhir:udi  ( [ Reference(Device) ] ... ) ; # 0..* Unique device identifier
      fhir:subDetail ( [ # 0..* Product or service provided
        fhir:sequence [ positiveInt ] ; # 1..1 Item instance identifier
        fhir:traceNumber  ( [ Identifier ] ... ) ; # 0..* Number for tracking
        fhir:revenue [ CodeableConcept ] ; # 0..1 Revenue or cost center code
        fhir:category [ CodeableConcept ] ; # 0..1 Benefit classification
        fhir:productOrService [ CodeableConcept ] ; # 0..1 Billing, service, product, or drug code
        fhir:productOrServiceEnd [ CodeableConcept ] ; # 0..1 End of a range of codes
        fhir:modifier  ( [ CodeableConcept ] ... ) ; # 0..* Service/Product billing modifiers
        fhir:programCode  ( [ CodeableConcept ] ... ) ; # 0..* Program the product or service is provided under
        fhir:patientPaid [ Money ] ; # 0..1 Paid by the patient
        fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 Count of products or services
        fhir:unitPrice [ Money ] ; # 0..1 Fee, charge or cost per item
        fhir:factor [ decimal ] ; # 0..1 Price scaling factor
        fhir:tax [ Money ] ; # 0..1 Total tax
        fhir:net [ Money ] ; # 0..1 Total item cost
        fhir:udi  ( [ Reference(Device) ] ... ) ; # 0..* Unique device identifier
      ] ... ) ;
    ] ... ) ;
  ] ... ) ;
  fhir:total [ Money ] ; # 0..1 Total claim cost

]

Changes since DSTU2 from both R4 and R4B

Claim.status Added Element Claim.type Claim.use Change value set from http://hl7.org/fhir/ValueSet/claim-use-link to http://hl7.org/fhir/ValueSet/claim-use Claim.patient Min Cardinality changed from 1 to 0 Claim.item.unitPrice Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money Claim.item.detail.unitPrice Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money Claim.item.detail.net Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money Claim.item.detail.udi Max Cardinality changed from 1 to * Type changed from Coding to Reference(Device) Claim.item.detail.subDetail.unitPrice Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money Claim.item.detail.subDetail.net Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money Claim.item.detail.subDetail.udi Max Cardinality changed from 1 to * Type changed from Coding to Reference(Device)
Claim Min Cardinality changed from 1 to 0 Type changed from code to CodeableConcept Change value set from http://hl7.org/fhir/ValueSet/claim-type-link to http://hl7.org/fhir/ValueSet/claim-type
Claim.subType Claim.traceNumber
  • Added Element
Claim.billablePeriod Claim.statusReason
  • Added Element
Claim.insurer Claim.subject
  • Added Mandatory Element
Claim.priority Type changed from Coding to CodeableConcept Claim.fundsReserve Claim.enterer
  • Type changed from Coding to CodeableConcept Claim.related Added Element Claim.related.claim Added Element Claim.related.relationship Added Element Claim.related.reference Reference: Added Element Claim.prescription Remove Reference(MedicationOrder), Add Reference(MedicationRequest) Target Types Patient, RelatedPerson
Claim.originalPrescription Claim.provider
  • Type Min Cardinality changed from Reference(MedicationOrder) 1 to Reference(MedicationRequest) 0
Claim.payee.type Claim.priority
  • Min Cardinality changed from 0 to 1 Type changed from Coding to CodeableConcept Claim.payee.resourceType Added Element Claim.payee.party Added Element Claim.careTeam Added Element 0
Claim.careTeam.sequence Claim.prescription
  • Type Reference: Added Element Target Type ServiceRequest
Claim.careTeam.provider Claim.originalPrescription
  • Type Reference: Added Element Target Type ServiceRequest
Claim.careTeam.responsible Claim.encounter
  • Added Element
Claim.careTeam.role Claim.facility
  • Type Reference: Added Element Target Type Organization
Claim.careTeam.qualification Claim.diagnosisRelatedGroup
  • Added Element
Claim.information Claim.event
  • Added Element
Claim.information.sequence Claim.event.type
  • Added Mandatory Element
Claim.information.category Claim.event.when[x]
  • Added Mandatory Element
Claim.information.code Claim.careTeam.specialty
  • Added Element
Claim.information.timing[x] Claim.supportingInfo.subCategory
  • Added Element
Claim.information.value[x] Claim.supportingInfo.timing[x]
  • Added Element Add Types dateTime, Timing
    • Claim.information.reason
  • Added Element Remove Type date
Claim.diagnosis.diagnosis[x] Claim.supportingInfo.value[x]
  • Renamed from diagnosis to diagnosis[x] Remove Coding, Add Types base64Binary, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, CodeableConcept, Add Reference(Condition) Claim.diagnosis.type Added Element Claim.diagnosis.packageCode Added Element Claim.procedure Added Element Claim.procedure.sequence Added Element Claim.procedure.date Added Element Claim.procedure.procedure[x] Added Element Claim.insurance Added Element Claim.insurance.sequence Added Element Claim.insurance.focal Added Element Claim.insurance.coverage Added Element Claim.insurance.businessArrangement Added Element Claim.insurance.preAuthRef Added Element Claim.insurance.claimResponse Added Element CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Range, Ratio, RatioRange, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, VirtualServiceDetail, Dosage, Meta
Claim.accident Claim.insurance
  • Type Min Cardinality changed from date 1 to BackboneElement Claim.accident.date Added Element Claim.accident.type Added Element Claim.accident.location[x] Added Element Claim.employmentImpacted Added Element Claim.hospitalization Added Element Claim.item.careTeamLinkId Added Element Claim.item.procedureLinkId Added Element 0
Claim.item.informationLinkId Claim.patientPaid
  • Added Element
Claim.item.revenue Claim.item.traceNumber
  • Added Element
Claim.item.category Claim.item.subject
  • Added Element
Claim.item.service Claim.item.productOrService
  • Min Cardinality changed from 1 to 0
    • Type changed from Coding to CodeableConcept Claim.item.modifier Type changed from Coding to CodeableConcept
Claim.item.programCode Claim.item.productOrServiceEnd
  • Added Element
Claim.item.serviced[x] Claim.item.request
  • Added Element
Claim.item.location[x] Claim.item.patientPaid
  • Added Element
Claim.item.net Claim.item.tax
  • Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money Added Element
Claim.item.udi Claim.item.bodySite
  • Max Cardinality changed from 1 to *
  • Type changed from Coding to Reference(Device) Claim.item.bodySite Type changed from Coding to CodeableConcept Claim.item.subSite Type changed from Coding to CodeableConcept BackboneElement
Claim.item.encounter Claim.item.bodySite.site
  • Added Mandatory Element
Claim.item.detail.revenue Claim.item.bodySite.subSite
  • Added Element
Claim.item.detail.category Claim.item.detail.traceNumber
  • Added Element
Claim.item.detail.service Claim.item.detail.productOrService
  • Min Cardinality changed from 1 to 0
    • Type changed from Coding to CodeableConcept
Claim.item.detail.modifier Claim.item.detail.productOrServiceEnd
  • Added Element
Claim.item.detail.programCode Claim.item.detail.patientPaid
  • Added Element
Claim.item.detail.subDetail.revenue Claim.item.detail.tax
  • Added Element
Claim.item.detail.subDetail.category Claim.item.detail.subDetail.traceNumber
  • Added Element
Claim.item.detail.subDetail.service Claim.item.detail.subDetail.productOrService
  • Min Cardinality changed from 1 to 0
    • Type changed from Coding to CodeableConcept
Claim.item.detail.subDetail.modifier Claim.item.detail.subDetail.productOrServiceEnd
  • Added Element
Claim.item.detail.subDetail.programCode Claim.item.detail.subDetail.patientPaid
  • Added Element
Claim.total Claim.item.detail.subDetail.tax
  • Added Element
Claim.ruleset deleted Claim.originalRuleset deleted Claim.target deleted Claim.payee.provider deleted Claim.payee.organization deleted Claim.payee.person deleted Claim.condition deleted Claim.coverage deleted Claim.exception deleted Claim.school deleted Claim.accidentType deleted Claim.interventionException deleted Claim.item.type deleted Claim.item.provider deleted Claim.item.serviceDate deleted Claim.item.points deleted Claim.item.detail.type deleted Claim.item.detail.points deleted Claim.item.detail.subDetail.type Claim.patient
  • deleted Deleted
Claim.item.detail.subDetail.points Claim.careTeam.responsible
  • deleted Deleted
Claim.item.prosthesis Claim.careTeam.qualification
  • deleted Deleted
Claim.additionalMaterials Claim.diagnosis.packageCode
  • deleted Deleted
Claim.missingTeeth Claim.item.subSite
  • deleted Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON .

Structure

0..1 Type Finer grained complete | proposed Period Creation Funds requested Related file Party to be paid any Type Number to covey order of careTeam boolean Role on Type, classification General class Type timingDate timingPeriod Period Reason associated with Package billing code Procedures Service Is the focal Type of service or product Billing Code Service/Product Service Service Type of service or product Billing Code Service Type of service or product Billing Code
Name Flags Card. Type Description & Constraints      Filter: Filters doco
. . Claim TU DomainResource Claim, Pre-determination or Pre-authorization

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier 0..* Identifier Business Identifier for claim

... traceNumber 0..* Identifier Number for tracking
Claim number
. . . status ?! Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: Financial Resource Status Codes ( Required )
. . type . statusReason Σ 0..1 string Reason for status change
... type Σ 1..1 CodeableConcept Category or discipline
Example Binding: Claim Type Codes ( Required Extensible )
. . . subType 0..* 0..1 CodeableConcept More granular claim type information
Binding: Example Claim SubType Codes ( Example )
. . . use Σ 0..1 1..1 code claim | exploratory preauthorization | other predetermination
Binding: Use ( Required )
. . . patient subject Σ 0..1 1..1 Reference ( Patient | Group ) The subject recipient(s) of the Products products and Services services
. . . billablePeriod Σ 0..1 Period Relevant time frame for charge submission the claim
. . . created Σ 0..1 1..1 dateTime Resource creation date
. . . enterer 0..1 Reference ( Practitioner | PractitionerRole | Patient | RelatedPerson ) Author of the claim
. . . insurer Σ 0..1 Reference ( Organization ) Target
. . . provider Σ 0..1 Reference ( Practitioner ) Responsible provider organization 0..1 Reference | PractitionerRole ( | Organization ) Party responsible for the claim
Responsible organization
. . . priority Σ 0..1 CodeableConcept Desired processing priority urgency
Binding: Process Priority Codes ( Example Preferred )
. . . fundsReserve 0..1 CodeableConcept For whom to be reserved reserve funds
Binding: Funds Reservation Codes ( Example Preferred )
. . . related 0..* BackboneElement Prior or corollary claims
Related Claims which may be revelant to processing this claimn
. . . . claim 0..1 Reference ( Claim ) Reference to the related claim
. . . . relationship 0..1 CodeableConcept How the reference claim is related
Binding: Example Related Claim Relationship Codes ( Example )
. . . . reference 0..1 Identifier File or case reference
. . . prescription 0..1 Reference ( DeviceRequest | MedicationRequest | ServiceRequest | VisionPrescription ) Prescription authorizing services or and products
. . . originalPrescription 0..1 Reference ( DeviceRequest | MedicationRequest | ServiceRequest | VisionPrescription ) Original prescription if superceded superseded by fulfiller
. . . payee 0..1 BackboneElement Recipient of benefits payable
. . . . type 1..1 CodeableConcept Category of party: Subscriber, Provider, other recipient
Binding: Claim Payee Type Codes ( Example )
. . . resourceType . party 0..1 Coding Reference ( Practitioner organization | patient PractitionerRole | practitioner Organization | relatedperson ClaimPayeeResourceType Patient ( Example | RelatedPerson ) Recipient reference
. . party . referral 0..1 Reference ( Practitioner | Organization | Patient | RelatedPerson ServiceRequest ) Treatment referral
Party to receive the payable
. . . referral encounter 0..1 0..* Reference ( ReferralRequest Encounter ) Encounters associated with the listed treatments

Treatment Referral
. . . facility 0..1 Reference ( Location | Organization ) Servicing Facility facility
. . careTeam . diagnosisRelatedGroup 0..1 CodeableConcept 0..* Package billing code
Binding: Example Diagnosis Related Group Codes ( Example )
. . . event 0..* BackboneElement Event information
Members of the care team
. . . sequence . type 1..1 CodeableConcept positiveInt Specific event
Binding: Dates Type Codes ( Example )
. . . . when[x] 1..1 Occurance date or period
. . . . provider . whenDateTime dateTime
. . . . . whenPeriod 1..1 Reference Period ( Practitioner
. . . careTeam | Organization ) 0..* BackboneElement Members of the care team

Provider individual or organization
. . . responsible . sequence 1..1 positiveInt Order of care team
0..1
. . . . provider 1..1 Reference ( Practitioner | PractitionerRole | Organization ) Practitioner or organization
Billing provider
. . . . role 0..1 CodeableConcept Function within the team
Binding: Claim Care Team Role Codes ( Example Preferred )
. . . . qualification specialty 0..1 CodeableConcept Practitioner or Specialization provider specialization
Binding: Example Provider Qualification Codes ( Example )
. . information . supportingInfo 0..* BackboneElement Supporting information
Exceptions, special considerations, the condition, situation, prior or concurrent issues
. . . . sequence 1..1 positiveInt Information instance identifier
. . . . category 1..1 CodeableConcept Classification of the supplied information
Binding: Claim Information Category Codes ( Example Preferred )
. . . . code subCategory 0..1 CodeableConcept Finer-grained classification of the supplied information
Exception Codes Binding: InformationSubCategory ( Example )
. . . timing[x] . code 0..1 When it occurred 0..1 date CodeableConcept Type of information
Binding: Exception Codes ( Example )
. . . . value[x] timing[x] 0..1 When it occurred
Additional Data or supporting information
. . . . valueString . timingDateTime string dateTime
. . . . . valueQuantity timingPeriod Quantity Period
. . . . valueAttachment . timingTiming Attachment Timing
. . . valueReference . value[x] 0..1 Reference ( Any * ) Data to be provided
. . . . reason 0..1 CodeableConcept Explanation for the information
Binding: Missing Tooth Reason Codes ( Example )
. . . diagnosis 0..* BackboneElement Pertinent diagnosis information
List of Diagnosis
. . . . sequence 1..1 positiveInt Diagnosis instance identifier
Number to covey order of diagnosis
. . . . diagnosis[x] 1..1 Patient's diagnosis Nature of illness or problem
Binding: ICD-10 Codes ( Example )
. . . . . diagnosisCodeableConcept CodeableConcept
. . . . . diagnosisReference Reference ( Condition )
. . . . type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: Example Diagnosis Type Codes ( Example Preferred )

. . . . packageCode onAdmission 0..1 CodeableConcept Present on admission
Binding: Example Diagnosis Related Group on Admission Codes ( Example Preferred )
. . . procedure 0..* BackboneElement Clinical procedures performed

. . . . sequence 1..1 positiveInt Procedure instance identifier
. . . . type 0..* CodeableConcept Category of Procedure sequence for reference
Binding: Example Procedure Type Codes ( Preferred )

. . . . date 0..1 dateTime When the procedure was performed
. . . . procedure[x] 1..1 Patient's list of procedures performed Specific clinical procedure
Binding: ICD-10 Procedure Codes ( Example )
. . . . . procedureCodeableConcept CodeableConcept
. . . . . procedureReference Reference ( Procedure )
. . . . udi 0..* Reference ( Device ) Unique device identifier

... insurance Σ 0..* BackboneElement Patient insurance information
Insurance or medical plan
. . . . sequence Σ 1..1 positiveInt Insurance instance identifier
. . . . focal Σ 1..1 boolean Coverage to be used for adjudication
. . . . identifier 0..1 Identifier Pre-assigned Claim number
.... coverage Σ 1..1 Reference ( Coverage ) Insurance information
. . . . businessArrangement 0..1 string Additional provider contract number
Business agreement
. . . . preAuthRef 0..* string Prior authorization reference number
Pre-Authorization/Determination Reference
. . . . claimResponse 0..1 Reference ( ClaimResponse ) Adjudication results
. . . accident 0..1 BackboneElement Details about an accident of the event
. . . . date 1..1 date When the accident incident occurred see information codes see information codes
. . . . type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode icon ( Required Extensible )
. . . . location[x] 0..1 Where the event occurred
Accident Place
. . . . . locationAddress Address
. . . . . locationReference Reference ( Location )
. . employmentImpacted . patientPaid 0..1 Period Money Paid by the patient
Period unable to work
. . hospitalization . item 0..* BackboneElement 0..1 Product or service provided

Period
. . . . sequence 1..1 positiveInt Item instance identifier
Period in hospital
. . . item . traceNumber 0..* BackboneElement Identifier Number for tracking
Goods and Services
. . . sequence . subject 1..1 0..1 positiveInt Reference ( Patient | Group ) The recipient of the products and services
Service instance
. . . . careTeamLinkId careTeamSequence 0..* positiveInt Applicable careTeam members

. . . diagnosisLinkId . diagnosisSequence 0..* positiveInt Applicable diagnoses

. . . . procedureLinkId procedureSequence 0..* positiveInt Applicable procedures

. . . informationLinkId . informationSequence 0..* positiveInt Applicable exception and supporting information

. . . . revenue 0..1 CodeableConcept Revenue or cost center code
Binding: Example Revenue Center Codes ( Example )
. . . . category 0..1 CodeableConcept Benefit classification
Binding: Benefit SubCategory Category Codes ( Example )
. . . . service productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLS Codes ( Example )
. . . modifier . productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLS Codes ( Example )
.... request 0..* Reference ( DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | VisionPrescription ) Request or Referral for Service

.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: Modifier type Codes ( Example )

. . . . programCode 0..* CodeableConcept Program specific reason for item inclusion the product or service is provided under
Binding: Example Program Reason Codes ( Example )

. . . . serviced[x] 0..1 Date or dates of Service service or product delivery
. . . . . servicedDate date
. . . . . servicedPeriod Period
. . . . location[x] 0..1 Place of service or where product was supplied
Binding: Example Service Place Codes ( Example )
. . . . . locationCodeableConcept CodeableConcept
. . . . . locationAddress Address
. . . . . locationReference Reference ( Location )
. . . . quantity patientPaid 0..1 Money Paid by the patient
.... quantity 0..1 SimpleQuantity Count of Products products or Services services
. . . . unitPrice 0..1 Money Fee, charge or cost per point item
. . . . factor 0..1 decimal Price scaling factor
. . . . net tax 0..1 Money Total tax
. . . . net 0..1 Money Total item cost
. . . . udi 0..* Reference ( Device ) Unique Device Identifier device identifier

. . . . bodySite 0..* BackboneElement 0..1 Anatomical location

CodeableConcept
. . . . . site Service 1..* CodeableReference ( BodyStructure ) Location
Binding: Oral Site Codes ( Example )

. . . . . subSite 0..* CodeableConcept Sub-location
Binding: Surface Codes ( Example )

. . . . encounter 0..* Reference ( Encounter ) Encounters related to this billed item associated with the listed treatments

. . . . detail 0..* BackboneElement Product or service provided
Additional items
. . . . . sequence 1..1 positiveInt Item instance identifier
. . . . . traceNumber 0..* Identifier Number for tracking

. . . . . revenue 0..1 CodeableConcept Revenue or cost center code
Binding: Example Revenue Center Codes ( Example )
. . . . . category 0..1 CodeableConcept Benefit classification
Binding: Benefit SubCategory Category Codes ( Example )
. . . . . service productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLS Codes ( Example )
. . . . . productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLS Codes ( Example )
. . . . . modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: Modifier type Codes ( Example )

. . . . . programCode 0..* CodeableConcept Program specific reason for item inclusion the product or service is provided under
Binding: Example Program Reason Codes ( Example )

. . . . . quantity patientPaid 0..1 Money Paid by the patient
..... quantity 0..1 SimpleQuantity Count of Products products or Services services
. . . . . unitPrice 0..1 Money Fee, charge or cost per point item
. . . . . factor 0..1 decimal Price scaling factor
. . . . . net tax 0..1 Money Total tax
. . . . . net 0..1 Money Total additional item cost
. . . . . udi 0..* Reference ( Device ) Unique Device Identifier device identifier

. . . . . subDetail 0..* BackboneElement Product or service provided
Additional items
. . . . . . sequence 1..1 positiveInt Item instance identifier
. . . . . . traceNumber 0..* Identifier Number for tracking

. . . . . . revenue 0..1 CodeableConcept Revenue or cost center code
Binding: Example Revenue Center Codes ( Example )
. . . . . . category 0..1 CodeableConcept Benefit classification
Binding: Benefit SubCategory Category Codes ( Example )
. . . . . . service productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLS Codes ( Example )
. . . . . . productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLS Codes ( Example )
. . . . . . modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: Modifier type Codes ( Example )

. . . . . . programCode 0..* CodeableConcept Program specific reason for item inclusion the product or service is provided under
Binding: Example Program Reason Codes ( Example )

. . . . . . quantity patientPaid 0..1 Money Paid by the patient
...... quantity 0..1 SimpleQuantity Count of Products products or Services services
. . . . . . unitPrice 0..1 Money Fee, charge or cost per point item
. . . . . . factor 0..1 decimal Price scaling factor
. . . . . . net tax 0..1 Money Total tax
...... net Net additional 0..1 Money Total item cost
. . . . . . udi 0..* Reference ( Device ) Unique Device Identifier device identifier

. . . total 0..1 Money Total claim cost

doco Documentation for this format icon

See the Extensions for this resource

UML Diagram ( Legend )

Claim ( DomainResource ) The business A unique identifier assigned to this claim identifier : Identifier [0..*] Trace number for tracking purposes. May be defined at the instance: claim number, pre-determination jurisdiction level or pre-authorization number between trading partners identifier traceNumber : Identifier [0..*] The status of the resource instance (this element modifies the meaning of other elements) status : code [0..1] [1..1] « A code specifying the state of the resource instance. null (Strength=Required) Financial Resource Status FinancialResourceStatusCodes ! » Used to indicate why the status has changed statusReason : string [0..1] The category of claim, eg, e.g. oral, pharmacy, vision, insitutional, institutional, professional type : CodeableConcept [0..1] [1..1] « The type or discipline-style of the claim (Strength=Required) null (Strength=Extensible) Example Claim Type ! ClaimTypeCodes + » A finer grained suite of claim subtype type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service. In the US the BillType service subType : CodeableConcept [0..*] [0..1] « A more granular claim typecode null (Strength=Example) Example Claim SubType ExampleClaimSubTypeCodes ?? » Complete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination) A code to indicate whether the nature of the request is: Claim - A request to an Insurer to adjudicate the supplied charges for health care goods and services under the identified policy and to pay the determined Benefit amount, if any; Preauthorization - A request to an Insurer to adjudicate the supplied proposed future charges for health care goods and services under the identified policy and to approve the services and provide the expected benefit amounts and potentially to reserve funds to pay the benefits when Claims for the indicated services are later submitted; or, Pre-determination - A request to an Insurer to adjudicate the supplied 'what if' charges for health care goods and services under the identified policy and report back what the Benefit payable would be had the services actually been provided use : code [0..1] [1..1] « Complete, proposed, exploratory, other null (Strength=Required) Use ! » Patient Resource The party/group to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought patient subject : Reference [0..1] [1..1] « Patient | Group » The billable period for which charges are being submitted billablePeriod : Period [0..1] The date when the enclosed suite of services were performed or completed this resource was created created : dateTime [0..1] [1..1] Person Individual who created the invoice/claim/pre-determination claim, predetermination or pre-authorization preauthorization enterer : Reference [0..1] « Practitioner | PractitionerRole | Patient | RelatedPerson » The Insurer who is target of the request insurer : Reference [0..1] « Organization » The provider which is responsible for the bill, claim pre-determination, pre-authorization claim, predetermination or preauthorization provider : Reference [0..1] « Practitioner | PractitionerRole | The organization which is responsible for the bill, claim pre-determination, pre-authorization organization : Reference [0..1] Organization » Immediate (STAT), best effort (NORMAL), The provider-required urgency of processing the request. Typical values include: stat, normal, deferred (DEFER) priority : CodeableConcept [0..1] « The timeliness with which processing is required: STAT, normal, Deferred (Strength=Example) null (Strength=Preferred) Process Priority ProcessPriorityCodes ?? ? » In the case of a Pre-Determination/Pre-Authorization the provider may request that A code to indicate whether and for whom funds in the amount of the expected Benefit are to be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested future claims fundsReserve : CodeableConcept [0..1] « For whom funds are to be reserved: (Patient, Provider, None). (Strength=Example) null (Strength=Preferred) Funds Reservation FundsReservationCodes ?? ? » Prescription is the document/authorization given to support the dispensing of Pharmacy or Vision claim author for them to provide products and services for which consideration (reimbursement) is sought. Could be a RX for medications, an 'order' for oxygen or wheelchair or physiotherapy treatments prescription : Reference [0..1] « DeviceRequest | MedicationRequest | ServiceRequest | VisionPrescription » Original prescription which has been superceded superseded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription' products originalPrescription : Reference [0..1] « DeviceRequest | MedicationRequest | ServiceRequest | VisionPrescription » The referral resource which lists information received by the date, practitioner, reason and other claim author, it is not to be used when the author generates a referral for a patient. A copy of that referral may be provided as supporting information information. Some insurers require proof of referral to pay for services or to pay specialist rates for services referral : Reference [0..1] ReferralRequest « ServiceRequest » Healthcare encounters related to this claim encounter : Reference [0..*] « Encounter » Facility where the services were provided facility : Reference [0..1] « Location | Organization » The start A package billing code or bundle code used to group products and optional end dates of when the patient was precluded from working due services to the treatable condition(s) a particular health condition (such as heart attack) which is based on a predetermined grouping code system employmentImpacted diagnosisRelatedGroup : Period CodeableConcept [0..1] « null (Strength=Example) ExampleDiagnosisRelatedGroupC... ?? » The start and optional end dates of when amount paid by the patient was confined patient, in total at the claim claim level or specifically for the item and detail level, to a treatment center the provider for goods and services hospitalization patientPaid : Period Money [0..1] The total value of the all the items in the claim total : Money [0..1] RelatedClaim Other claims which are related Reference to this claim such as prior claim versions or for a related services claim claim : Reference [0..1] « Claim » For example prior or umbrella A code to convey how the claims are related relationship : CodeableConcept [0..1] « Relationship of this claim to a related Claim null (Strength=Example) Example Related Claim Relatio... ExampleRelatedClaimRelationsh... ?? » An alternate organizational reference to the case or file to which this particular claim pertains - eg Property/Casualy insurer claim # or Workers Compensation case # reference : Identifier [0..1] Payee Type of Party to be reimbursed: Subscriber, subscriber, provider, other type : CodeableConcept [1..1] « A code for the party to be reimbursed. null (Strength=Example) Claim Payee Type ClaimPayeeTypeCodes ?? » Reference to the individual or organization | patient | practitioner | relatedperson to whom any payment will be made resourceType party : Coding Reference [0..1] « Practitioner | PractitionerRole | Organization | Patient | RelatedPerson » Event The A coded event such as when a service is expected or a card printed type of Claim payee Resource : CodeableConcept [1..1] « null (Strength=Example) ClaimPayeeResourceType DatesTypeCodes ?? » Party A date or period in the past or future indicating when the event occurred or is expectd to be reimbursed: Subscriber, provider, other occur party when[x] : Reference [0..1] Practitioner | Organization DataType | Patient [1..1] « dateTime | RelatedPerson Period » CareTeam Sequence of the careTeam which serves A number to order and provide a link uniquely identify care team entries sequence : positiveInt [1..1] Member of the team who provided the overall product or service provider : Reference [1..1] « Practitioner | Organization PractitionerRole | The party who is billing and responsible for the claimed good or service rendered to the patient responsible : boolean Organization [0..1] » The lead, assisting or supervising practitioner and their discipline if a multidisiplinary multidisciplinary team role : CodeableConcept [0..1] « The role codes for the care team members. (Strength=Example) null (Strength=Preferred) Claim Care Team Role ClaimCareTeamRoleCodes ?? ? » The qualification specialization of the practitioner or provider which is applicable for this service qualification specialty : CodeableConcept [0..1] « Provider professional qualifications null (Strength=Example) Example Provider Qualificatio... ExampleProviderQualificationC... ?? » SpecialCondition SupportingInformation Sequence of the information element which serves A number to provide a link uniquely identify supporting information entries sequence : positiveInt [1..1] The general class of the information supplied: information; exception; accident, employment; onset, etc category : CodeableConcept [1..1] « The valuset used for additional information null (Strength=Preferred) ClaimInformationCategoryCodes ? » A finer classification within the more general category codes. (Strength=Example) Claim Information Category subCategory ?? : CodeableConcept [0..1] « null (Strength=Example) InformationSubCategory?? » System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought which may influence the adjudication code : CodeableConcept [0..1] « The valuset used for additional information codes. null (Strength=Example) Exception ExceptionCodes ?? » The date when or period to which this information refers timing[x] : Type DataType [0..1] date « dateTime | Period | Timing » Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data value[x] : Type * [0..1] string | Quantity | Attachment | Reference ( Any ) For example, provides Provides the reason for: in the additional stay, or missing tooth or any other situation where a reason code is required in addition to the content reason : CodeableConcept [0..1] « Reason codes for the missing teeth null (Strength=Example) Missing Tooth Reason MissingToothReasonCodes ?? » Diagnosis Sequence of diagnosis which serves A number to provide a link uniquely identify diagnosis entries sequence : positiveInt [1..1] The diagnosis nature of illness or problem in a coded form or as a reference to an external defined Condition diagnosis[x] : Type DataType [1..1] « CodeableConcept | Reference ( Condition ); ICD10 Diagnostic codes null (Strength=Example) ICD-10 ICD10Codes ?? » The type of When the Diagnosis, for example: admitting, primary, secondary, discharge condition was observed or the relative ranking type : CodeableConcept [0..*] « The type of the diagnosis: admitting, principal, discharge (Strength=Example) null (Strength=Preferred) Example Diagnosis Type ExampleDiagnosisTypeCodes ?? ? » The package billing code, for example DRG, based on Indication of whether the assigned grouping code system diagnosis was present on admission to a facility packageCode onAdmission : CodeableConcept [0..1] « The DRG codes associated with the diagnosis (Strength=Example) null (Strength=Preferred) Example Diagnosis Related Gro... ExampleDiagnosisOnAdmissionCo... ?? ? » Procedure Sequence of procedures which serves A number to order and provide a link uniquely identify procedure entries sequence : positiveInt [1..1] When the condition was observed or the relative ranking type : CodeableConcept [0..*] « null (Strength=Preferred) ExampleProcedureTypeCodes ? » Date and optionally time the procedure was performed date : dateTime [0..1] The procedure code or reference to a Procedure resource which identifies the clinical intervention performed procedure[x] : Type DataType [1..1] « CodeableConcept | Reference ( Procedure ); ICD10 Procedure codes null (Strength=Example) ICD-10 Procedure ICD10ProcedureCodes ?? » Unique Device Identifiers associated with this line item udi : Reference [0..*] « Device » Insurance Sequence of coverage which serves A number to uniquely identify insurance entries and provide a link and sequence of coverages to convey coordination of benefit order sequence : positiveInt [1..1] A flag to indicate that this Coverage is the focus to be used for adjudication. The Coverage against which the adjudication of this claim is when set to be adjudicated true focal : boolean [1..1] The business identifier to be used when the claim is sent for adjudication against this insurance policy identifier : Identifier [0..1] Reference to the program or plan identification, underwriter or payor insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system coverage : Reference [1..1] « Coverage » The contract number of a A business agreement which describes number established between the terms provider and conditions the insurer for special business processing purposes businessArrangement : string [0..1] A list of references from Reference numbers previously provided by the Insurer insurer to which these the provider to be quoted on subsequent claims containing services pertain or products related to the prior authorization preAuthRef : string [0..*] The Coverages result of the adjudication details of the line items for the Coverage specified in this insurance claimResponse : Reference [0..1] « ClaimResponse » Accident Date of an accident which these event related to the products and services are addressing contained in the claim date : date [1..1] Type The type or context of accident: work, auto, etc the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers type : CodeableConcept [0..1] « Type of accident: work place, auto, etc. (Strength=Required) null (Strength=Extensible) ActIncidentCode ! + » Accident Place The physical location of the accident event location[x] : Type DataType [0..1] « Address | Reference ( Location ) » Item A service line number to uniquely identify item entries sequence : positiveInt [1..1] CareTeam applicable Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners traceNumber : Identifier [0..*] The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for facast reimbursement is sought subject : Reference [0..1] « Patient | Group » CareTeam members related to this service or product line careTeamLinkId careTeamSequence : positiveInt [0..*] Diagnosis applicable for this service or product line diagnosisLinkId diagnosisSequence : positiveInt [0..*] Procedures applicable for this service or product line procedureLinkId procedureSequence : positiveInt [0..*] Exceptions, special conditions and supporting information pplicable applicable for this service or product line informationLinkId informationSequence : positiveInt [0..*] The type of reveneu revenue or cost center providing the product and/or service revenue : CodeableConcept [0..1] « Codes for the revenue or cost centers supplying the service and/or products. null (Strength=Example) Example Revenue Center ExampleRevenueCenterCodes ?? » Health Care Service Type Codes Code to identify the classification general type of service or benefits under which products and services are provided category : CodeableConcept [0..1] « Benefit subcategories such as: oral-basic, major, glasses null (Strength=Example) Benefit SubCategory BenefitCategoryCodes ?? » If this When the value is an actual service or product line, ie. not a Group, then use group code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,RXNorm,ACHI,CCI). If a grouping item then use this item collects a group set of related item details, otherwise this contains the product, service, drug or other billing code to indicate for the type item. This element may be the start of thing being grouped eg. 'glasses' a range of .productOrService codes used in conjunction with .productOrServiceEnd or 'compound' it may be a solo element where .productOrServiceEnd is not used service productOrService : CodeableConcept [0..1] « Allowable service and product codes null (Strength=Example) USCLS USCLSCodes ?? » Item typification This contains the end of a range of product, service, drug or modifiers codes, eg other billing codes for Oral whether the treatment item. This element is cosmetic or associated with TMJ, or for medical whether not used when the treatment was outside .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the clinic or out start of office hours the range. Typically this value may be used only with preauthorizations and not with claims modifier productOrServiceEnd : CodeableConcept [0..1] « null (Strength=Example) USCLSCodes ?? » Request or Referral for Goods or Service to be rendered request : Reference [0..*] « DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | VisionPrescription » Item type typification or modifiers codes, eg codes to convey additional context for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost product or stolen. service modifier : CodeableConcept [0..*] « null (Strength=Example) Modifier type ModifierTypeCodes ?? » For programs which require reason codes for the inclusion or covering of this billed item under Identifies the program or sub-program under which this may be recovered programCode : CodeableConcept [0..*] « Program specific reason codes null (Strength=Example) Example Program Reason ExampleProgramReasonCodes ?? » The date or dates when the enclosed suite of services were service or product was supplied, performed or completed serviced[x] : Type DataType [0..1] « date | Period » Where the product or service was provided location[x] : Type DataType [0..1] « CodeableConcept | Address | Reference ( Location ); Place of service: pharmacy,school, prison, etc. null (Strength=Example) Example Service Place ExampleServicePlaceCodes ?? » The amount paid by the patient, in total at the claim claim level or specifically for the item and detail level, to the provider for goods and services patientPaid : Money [0..1] The number of repetitions of a service or product quantity : Quantity ( SimpleQuantity ) [0..1] If the item is not a node group then this is the fee for the product or service, otherwise this is the total of the fees for the children details of the group unitPrice : Money [0..1] A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount factor : decimal [0..1] The quantity times the unit price total of taxes applicable for an addittional service or this product or charge. For example, service tax : Money [0..1] The total amount claimed for the formula: unit Quantity * group (if a grouper) or the line item. Net = unit Price (Cost per Point) price * factor Number quantity * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied net : Money [0..1] List of Unique Device Identifiers associated with this line item udi : Reference [0..*] « Device » Healthcare encounters related to this claim encounter : Reference [0..*] « Encounter » BodySite Physical service site on the patient (limb, tooth, etc) etc.) bodySite site : CodeableConcept CodeableReference [0..1] [1..*] « BodyStructure ; The code for the teeth, quadrant, sextant and arch null (Strength=Example) Oral Site OralSiteCodes ?? » A region or surface of the site, eg. bodySite, e.g. limb region or tooth surface(s) subSite : CodeableConcept [0..*] « The code for the tooth surface and surface combinations null (Strength=Example) Surface SurfaceCodes ?? » A billed item may include goods or services provided in multiple encounters encounter : Reference [0..*] Encounter Detail A service line number to uniquely identify item entries sequence : positiveInt [1..1] Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners traceNumber : Identifier [0..*] The type of reveneu revenue or cost center providing the product and/or service revenue : CodeableConcept [0..1] « Codes for the revenue or cost centers supplying the service and/or products. null (Strength=Example) Example Revenue Center ExampleRevenueCenterCodes ?? » Health Care Service Type Codes Code to identify the classification general type of service or benefits under which products and services are provided category : CodeableConcept [0..1] « Benefit subcategories such as: oral-basic, major, glasses null (Strength=Example) Benefit SubCategory BenefitCategoryCodes ?? » If this When the value is an actual service or product line, ie. not a Group, then use group code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use this item collects a group set of related item details, otherwise this contains the product, service, drug or other billing code to indicate for the type item. This element may be the start of thing being grouped eg. 'glasses' a range of .productOrService codes used in conjunction with .productOrServiceEnd or 'compound' it may be a solo element where .productOrServiceEnd is not used service productOrService : CodeableConcept [0..1] « Allowable service and product codes null (Strength=Example) USCLS USCLSCodes ?? » Item typification This contains the end of a range of product, service, drug or modifiers codes, eg other billing codes for Oral whether the treatment item. This element is cosmetic or associated with TMJ, or for medical whether not used when the treatment was outside .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the clinic or out start of office hours the range. Typically this value may be used only with preauthorizations and not with claims modifier productOrServiceEnd : CodeableConcept [0..*] [0..1] « null (Strength=Example) USCLSCodes ?? » Item type typification or modifiers codes, eg codes to convey additional context for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost product or stolen. service modifier : CodeableConcept [0..*] « null (Strength=Example) Modifier type ModifierTypeCodes ?? » For programs which require reson codes for the inclusion, covering, of this billed item under Identifies the program or sub-program under which this may be recovered programCode : CodeableConcept [0..*] « Program specific reason codes null (Strength=Example) Example Program Reason ExampleProgramReasonCodes ?? » The amount paid by the patient, in total at the claim claim level or specifically for the item and detail level, to the provider for goods and services patientPaid : Money [0..1] The number of repetitions of a service or product quantity : Quantity ( SimpleQuantity ) [0..1] If the item is not a node group then this is the fee for the product or service, otherwise this is the total of the fees for the children details of the group unitPrice : Money [0..1] A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount factor : decimal [0..1] The quantity times the unit price total of taxes applicable for an addittional service or this product or charge. For example, service tax : Money [0..1] The total amount claimed for the formula: unit Quantity * group (if a grouper) or the line item.detail. Net = unit Price (Cost per Point) price * factor Number quantity * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied net : Money [0..1] List of Unique Device Identifiers associated with this line item udi : Reference [0..*] « Device » SubDetail A service line number to uniquely identify item entries sequence : positiveInt [1..1] Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners traceNumber : Identifier [0..*] The type of reveneu revenue or cost center providing the product and/or service revenue : CodeableConcept [0..1] « Codes for the revenue or cost centers supplying the service and/or products. null (Strength=Example) Example Revenue Center ExampleRevenueCenterCodes ?? » Health Care Service Type Codes Code to identify the classification general type of service or benefits under which products and services are provided category : CodeableConcept [0..1] « Benefit subcategories such as: oral-basic, major, glasses null (Strength=Example) Benefit SubCategory BenefitCategoryCodes ?? » A When the value is a group code to indicate then this item collects a set of related item details, otherwise this contains the Professional Service product, service, drug or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI) other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used service productOrService : CodeableConcept [0..1] « Allowable service and product codes null (Strength=Example) USCLS USCLSCodes ?? » Item typification This contains the end of a range of product, service, drug or modifiers codes, eg other billing codes for Oral whether the treatment item. This element is cosmetic or associated with TMJ, or for medical whether not used when the treatment was outside .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the clinic or out start of office hours the range. Typically this value may be used only with preauthorizations and not with claims modifier productOrServiceEnd : CodeableConcept [0..*] [0..1] « null (Strength=Example) USCLSCodes ?? » Item type typification or modifiers codes, eg codes to convey additional context for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost product or stolen. service modifier : CodeableConcept [0..*] « null (Strength=Example) Modifier type ModifierTypeCodes ?? » For programs which require reson codes for the inclusion, covering, of this billed item under Identifies the program or sub-program under which this may be recovered programCode : CodeableConcept [0..*] « Program specific reason codes null (Strength=Example) Example Program Reason ExampleProgramReasonCodes ?? » The amount paid by the patient, in total at the claim claim level or specifically for the item and detail level, to the provider for goods and services patientPaid : Money [0..1] The number of repetitions of a service or product quantity : Quantity ( SimpleQuantity ) [0..1] The If the item is not a group then this is the fee for an addittional service or the product or charge service, otherwise this is the total of the fees for the details of the group unitPrice : Money [0..1] A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount factor : decimal [0..1] The quantity times the unit price total of taxes applicable for an addittional service or this product or charge. For example, the formula: unit Quantity * service tax : Money [0..1] The total amount claimed for line item.detail.subDetail. Net = unit Price (Cost per Point) price * factor Number quantity * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied net : Money [0..1] List of Unique Device Identifiers associated with this line item udi : Reference [0..*] « Device » Other claims which are related to this claim such as prior claim versions submissions or claims for related services or for the same event related [0..*] The party to be reimbursed for cost of the products and services according to the terms of the policy payee [0..1] Information code for an event with a corresponding date or period event [0..*] The members of the team who provided the overall service as well as their role and whether responsible products and qualifications services careTeam [0..*] Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required issues information supportingInfo [0..*] List of patient diagnosis for which care is sought Information about diagnoses relevant to the claim items diagnosis [0..*] Ordered list of patient procedures Procedures performed on the patient relevant to support the adjudication billing items with the claim procedure [0..*] Financial instrument by which payment information instruments for reimbursement for the health care products and services specified on the claim insurance [0..*] An Details of an accident which resulted in injuries which required the need for healthcare products and services listed in the claim accident [0..1] Third tier Physical location where the service is performed or applies bodySite [0..*] A claim detail line. Either a simple (a product or service) or a 'group' of goods and services sub-details which are simple items subDetail [0..*] Second tier A claim detail line. Either a simple (a product or service) or a 'group' of goods and services sub-details which are simple items detail [0..*] First tier A claim line. Either a simple product or service or a 'group' of goods and services details which can each be a simple items or groups of sub-details item [0..*]

XML Template 

<

<Claim xmlns="http://hl7.org/fhir"> doco

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <</identifier>
 <
 <</type>
 <</subType>
 <
 <</patient>
 <</billablePeriod>
 <
 <</enterer>

 <identifier><!-- 0..* Identifier Business Identifier for claim --></identifier>
 <traceNumber><!-- 0..* Identifier Number for tracking --></traceNumber>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <statusReason value="[string]"/><!-- 0..1 Reason for status change -->
 <type><!-- 1..1 CodeableConcept Category or discipline --></type>
 <subType><!-- 0..1 CodeableConcept More granular claim type --></subType>
 <use value="[code]"/><!-- 1..1 claim | preauthorization | predetermination -->
 <subject><!-- 1..1 Reference(Group|Patient) The recipient(s) of the products and services --></subject>
 <billablePeriod><!-- 0..1 Period Relevant time frame for the claim --></billablePeriod>
 <created value="[dateTime]"/><!-- 1..1 Resource creation date -->
 <enterer><!-- 0..1 Reference(Patient|Practitioner|PractitionerRole|RelatedPerson) Author of the claim --></enterer>

 <insurer><!-- 0..1 Reference(Organization) Target --></insurer>
 <</provider>
 <</organization>
 <</priority>
 <</fundsReserve>
 <
  <</claim>
  <</relationship>
  <</reference>

 <provider><!-- 0..1 Reference(Organization|Practitioner|PractitionerRole) Party responsible for the claim --></provider>
 <priority><!-- 0..1 CodeableConcept Desired processing urgency --></priority>
 <fundsReserve><!-- 0..1 CodeableConcept For whom to reserve funds --></fundsReserve>
 <related>  <!-- 0..* Prior or corollary claims -->
  <claim><!-- 0..1 Reference(Claim) Reference to the related claim --></claim>
  <relationship><!-- 0..1 CodeableConcept How the reference claim is related --></relationship>
  <reference><!-- 0..1 Identifier File or case reference --></reference>

 </related>
 <</prescription>
 <</originalPrescription>
 <
  <</type>
  <</resourceType>
  <</party>

 <prescription><!-- 0..1 Reference(DeviceRequest|MedicationRequest|ServiceRequest|
   VisionPrescription) Prescription authorizing services and products --></prescription>

 <originalPrescription><!-- 0..1 Reference(DeviceRequest|MedicationRequest|
   ServiceRequest|VisionPrescription) Original prescription if superseded by fulfiller --></originalPrescription>

 <payee>  <!-- 0..1 Recipient of benefits payable -->
  <type><!-- 1..1 CodeableConcept Category of recipient --></type>
  <party><!-- 0..1 Reference(Organization|Patient|Practitioner|PractitionerRole|
    RelatedPerson) Recipient reference --></party>
 </payee>
 <</referral>
 <</facility>
 <
  <
  <</provider>
  <
  <</role>
  <</qualification>

 <referral><!-- 0..1 Reference(ServiceRequest) Treatment referral --></referral>
 <encounter><!-- 0..* Reference(Encounter) Encounters associated with the listed treatments --></encounter>
 <facility><!-- 0..1 Reference(Location|Organization) Servicing facility --></facility>
 <diagnosisRelatedGroup><!-- 0..1 CodeableConcept Package billing code --></diagnosisRelatedGroup>
 <event>  <!-- 0..* Event information -->
  <type><!-- 1..1 CodeableConcept Specific event --></type>
  <when[x]><!-- 1..1 dateTime|Period Occurance date or period --></when[x]>
 </event>
 <careTeam>  <!-- 0..* Members of the care team -->
  <sequence value="[positiveInt]"/><!-- 1..1 Order of care team -->
  <provider><!-- 1..1 Reference(Organization|Practitioner|PractitionerRole) Practitioner or organization --></provider>
  <role><!-- 0..1 CodeableConcept Function within the team --></role>
  <specialty><!-- 0..1 CodeableConcept Practitioner or provider specialization --></specialty>

 </careTeam>
 <
  <
  <</category>
  <</code>
  <</timing[x]>
  <</value[x]>
  <</reason>
 </information>
 <
  <
  <</diagnosis[x]>
  <</type>
  <</packageCode>

 <supportingInfo>  <!-- 0..* Supporting information -->
  <sequence value="[positiveInt]"/><!-- 1..1 Information instance identifier -->
  <category><!-- 1..1 CodeableConcept Classification of the supplied information --></category>
  <subCategory><!-- 0..1 CodeableConcept Finer-grained classification of the supplied information --></subCategory>
  <code><!-- 0..1 CodeableConcept Type of information --></code>
  <timing[x]><!-- 0..1 dateTime|Period|Timing When it occurred --></timing[x]>
  <value[x]><!-- 0..1 * Data to be provided --></value[x]>
  <reason><!-- 0..1 CodeableConcept Explanation for the information --></reason>
 </supportingInfo>
 <diagnosis>  <!-- 0..* Pertinent diagnosis information -->
  <sequence value="[positiveInt]"/><!-- 1..1 Diagnosis instance identifier -->
  <diagnosis[x]><!-- 1..1 CodeableConcept|Reference(Condition) Nature of illness or problem --></diagnosis[x]>
  <type><!-- 0..* CodeableConcept Timing or nature of the diagnosis --></type>
  <onAdmission><!-- 0..1 CodeableConcept Present on admission --></onAdmission>

 </diagnosis>
 <
  <
  <
  <</procedure[x]>

 <procedure>  <!-- 0..* Clinical procedures performed -->
  <sequence value="[positiveInt]"/><!-- 1..1 Procedure instance identifier -->
  <type><!-- 0..* CodeableConcept Category of Procedure --></type>
  <date value="[dateTime]"/><!-- 0..1 When the procedure was performed -->
  <procedure[x]><!-- 1..1 CodeableConcept|Reference(Procedure) Specific clinical procedure --></procedure[x]>
  <udi><!-- 0..* Reference(Device) Unique device identifier --></udi>

 </procedure>
 <
  <
  <
  <</coverage>
  <
  <
  <</claimResponse>

 <insurance>  <!-- 0..* Patient insurance information -->
  <sequence value="[positiveInt]"/><!-- 1..1 Insurance instance identifier -->
  <focal value="[boolean]"/><!-- 1..1 Coverage to be used for adjudication -->
  <identifier><!-- 0..1 Identifier Pre-assigned Claim number --></identifier>
  <coverage><!-- 1..1 Reference(Coverage) Insurance information --></coverage>
  <businessArrangement value="[string]"/><!-- 0..1 Additional provider contract number -->
  <preAuthRef value="[string]"/><!-- 0..* Prior authorization reference number -->
  <claimResponse><!-- 0..1 Reference(ClaimResponse) Adjudication results --></claimResponse>

 </insurance>
 <
  <When the accident occurred
see information codes
see information codes
  <</type>
  <</location[x]>

 <accident>  <!-- 0..1 Details of the event -->
  <date value="[date]"/><!-- 1..1 When the incident occurred -->
  <type><!-- 0..1 CodeableConcept The nature of the accident icon --></type>
  <location[x]><!-- 0..1 Address|Reference(Location) Where the event occurred --></location[x]>

 </accident>
 <</employmentImpacted>
 <</hospitalization>
 <
  <
  <
  <
  <
  <
  <</revenue>
  <</category>
  <</service>
  <</modifier>
  <</programCode>
  <</serviced[x]>
  <</location[x]>
  <</quantity>
  <</unitPrice>
  <
  <</net>
  <</udi>
  <</bodySite>
  <</subSite>
  <</encounter>
  <
   <
   <</revenue>
   <</category>
   <</service>
   <</modifier>
   <</programCode>
   <</quantity>
   <</unitPrice>
   <
   <</net>
   <</udi>
   <
    <
    <</revenue>
    <</category>
    <</service>
    <</modifier>
    <</programCode>
    <</quantity>
    <</unitPrice>
    <
    <</net>
    <</udi>

 <patientPaid><!-- 0..1 Money Paid by the patient --></patientPaid>
 <item>  <!-- 0..* Product or service provided -->
  <sequence value="[positiveInt]"/><!-- 1..1 Item instance identifier -->
  <traceNumber><!-- 0..* Identifier Number for tracking --></traceNumber>
  <subject><!-- 0..1 Reference(Group|Patient) The recipient of the products and services --></subject>
  <careTeamSequence value="[positiveInt]"/><!-- 0..* Applicable careTeam members -->
  <diagnosisSequence value="[positiveInt]"/><!-- 0..* Applicable diagnoses -->
  <procedureSequence value="[positiveInt]"/><!-- 0..* Applicable procedures -->
  <informationSequence value="[positiveInt]"/><!-- 0..* Applicable exception and supporting information -->
  <revenue><!-- 0..1 CodeableConcept Revenue or cost center code --></revenue>
  <category><!-- 0..1 CodeableConcept Benefit classification --></category>
  <productOrService><!-- 0..1 CodeableConcept Billing, service, product, or drug code --></productOrService>
  <productOrServiceEnd><!-- 0..1 CodeableConcept End of a range of codes --></productOrServiceEnd>
  <request><!-- 0..* Reference(DeviceRequest|MedicationRequest|NutritionOrder|
    ServiceRequest|VisionPrescription) Request or Referral for Service --></request>

  <modifier><!-- 0..* CodeableConcept Product or service billing modifiers --></modifier>
  <programCode><!-- 0..* CodeableConcept Program the product or service is provided under --></programCode>
  <serviced[x]><!-- 0..1 date|Period Date or dates of service or product delivery --></serviced[x]>
  <location[x]><!-- 0..1 CodeableConcept|Address|Reference(Location) Place of service or where product was supplied --></location[x]>
  <patientPaid><!-- 0..1 Money Paid by the patient --></patientPaid>
  <quantity><!-- 0..1 Quantity(SimpleQuantity) Count of products or services --></quantity>
  <unitPrice><!-- 0..1 Money Fee, charge or cost per item --></unitPrice>
  <factor value="[decimal]"/><!-- 0..1 Price scaling factor -->
  <tax><!-- 0..1 Money Total tax --></tax>
  <net><!-- 0..1 Money Total item cost --></net>
  <udi><!-- 0..* Reference(Device) Unique device identifier --></udi>
  <bodySite>  <!-- 0..* Anatomical location -->
   <site><!-- 1..* CodeableReference(BodyStructure) Location --></site>
   <subSite><!-- 0..* CodeableConcept Sub-location --></subSite>
  </bodySite>
  <encounter><!-- 0..* Reference(Encounter) Encounters associated with the listed treatments --></encounter>
  <detail>  <!-- 0..* Product or service provided -->
   <sequence value="[positiveInt]"/><!-- 1..1 Item instance identifier -->
   <traceNumber><!-- 0..* Identifier Number for tracking --></traceNumber>
   <revenue><!-- 0..1 CodeableConcept Revenue or cost center code --></revenue>
   <category><!-- 0..1 CodeableConcept Benefit classification --></category>
   <productOrService><!-- 0..1 CodeableConcept Billing, service, product, or drug code --></productOrService>
   <productOrServiceEnd><!-- 0..1 CodeableConcept End of a range of codes --></productOrServiceEnd>
   <modifier><!-- 0..* CodeableConcept Service/Product billing modifiers --></modifier>
   <programCode><!-- 0..* CodeableConcept Program the product or service is provided under --></programCode>
   <patientPaid><!-- 0..1 Money Paid by the patient --></patientPaid>
   <quantity><!-- 0..1 Quantity(SimpleQuantity) Count of products or services --></quantity>
   <unitPrice><!-- 0..1 Money Fee, charge or cost per item --></unitPrice>
   <factor value="[decimal]"/><!-- 0..1 Price scaling factor -->
   <tax><!-- 0..1 Money Total tax --></tax>
   <net><!-- 0..1 Money Total item cost --></net>
   <udi><!-- 0..* Reference(Device) Unique device identifier --></udi>
   <subDetail>  <!-- 0..* Product or service provided -->
    <sequence value="[positiveInt]"/><!-- 1..1 Item instance identifier -->
    <traceNumber><!-- 0..* Identifier Number for tracking --></traceNumber>
    <revenue><!-- 0..1 CodeableConcept Revenue or cost center code --></revenue>
    <category><!-- 0..1 CodeableConcept Benefit classification --></category>
    <productOrService><!-- 0..1 CodeableConcept Billing, service, product, or drug code --></productOrService>
    <productOrServiceEnd><!-- 0..1 CodeableConcept End of a range of codes --></productOrServiceEnd>
    <modifier><!-- 0..* CodeableConcept Service/Product billing modifiers --></modifier>
    <programCode><!-- 0..* CodeableConcept Program the product or service is provided under --></programCode>
    <patientPaid><!-- 0..1 Money Paid by the patient --></patientPaid>
    <quantity><!-- 0..1 Quantity(SimpleQuantity) Count of products or services --></quantity>
    <unitPrice><!-- 0..1 Money Fee, charge or cost per item --></unitPrice>
    <factor value="[decimal]"/><!-- 0..1 Price scaling factor -->
    <tax><!-- 0..1 Money Total tax --></tax>
    <net><!-- 0..1 Money Total item cost --></net>
    <udi><!-- 0..* Reference(Device) Unique device identifier --></udi>

   </subDetail>
  </detail>
 </item>
 <</total>

 <total><!-- 0..1 Money Total claim cost --></total>

</Claim>

JSON Template 

{doco
  "resourceType" : "",

  "resourceType" : "Claim",

  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
    "
    "
    "

  "identifier" : [{ Identifier }], // Business Identifier for claim
  "traceNumber" : [{ Identifier }], // Number for tracking
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  "statusReason" : "<string>", // Reason for status change
  "type" : { CodeableConcept }, // R!  Category or discipline
  "subType" : { CodeableConcept }, // More granular claim type
  "use" : "<code>", // R!  claim | preauthorization | predetermination
  "subject" : { Reference(Group|Patient) }, // R!  The recipient(s) of the products and services
  "billablePeriod" : { Period }, // Relevant time frame for the claim
  "created" : "<dateTime>", // R!  Resource creation date
  "enterer" : { Reference(Patient|Practitioner|PractitionerRole|RelatedPerson) }, // Author of the claim
  "insurer" : { Reference(Organization) }, // Target
  "provider" : { Reference(Organization|Practitioner|PractitionerRole) }, // Party responsible for the claim
  "priority" : { CodeableConcept }, // Desired processing urgency
  "fundsReserve" : { CodeableConcept }, // For whom to reserve funds
  "related" : [{ // Prior or corollary claims
    "claim" : { Reference(Claim) }, // Reference to the related claim
    "relationship" : { CodeableConcept }, // How the reference claim is related
    "reference" : { Identifier } // File or case reference

  }],
  "
  "
  "
    "
    "
    "

  "prescription" : { Reference(DeviceRequest|MedicationRequest|ServiceRequest|
   VisionPrescription) }, // Prescription authorizing services and products

  "originalPrescription" : { Reference(DeviceRequest|MedicationRequest|
   ServiceRequest|VisionPrescription) }, // Original prescription if superseded by fulfiller

  "payee" : { // Recipient of benefits payable
    "type" : { CodeableConcept }, // R!  Category of recipient
    "party" : { Reference(Organization|Patient|Practitioner|PractitionerRole|
    RelatedPerson) } // Recipient reference
  },
  "
  "
  "
    "
    "
    "
    "
    "

  "referral" : { Reference(ServiceRequest) }, // Treatment referral
  "encounter" : [{ Reference(Encounter) }], // Encounters associated with the listed treatments
  "facility" : { Reference(Location|Organization) }, // Servicing facility
  "diagnosisRelatedGroup" : { CodeableConcept }, // Package billing code
  "event" : [{ // Event information
    "type" : { CodeableConcept }, // R!  Specific event
    // when[x]: Occurance date or period. One of these 2:

    "whenDateTime" : "<dateTime>",
    "whenPeriod" : { Period }

  }],
  "
    "
    "
    "
    
    ">",
    " },
    
    ">",
    " },
    " },
    " },
    "

  "careTeam" : [{ // Members of the care team
    "sequence" : "<positiveInt>", // R!  Order of care team
    "provider" : { Reference(Organization|Practitioner|PractitionerRole) }, // R!  Practitioner or organization
    "role" : { CodeableConcept }, // Function within the team
    "specialty" : { CodeableConcept } // Practitioner or provider specialization

  }],
  "
    "
    
    " },
    " },
    "
    "

  "supportingInfo" : [{ // Supporting information
    "sequence" : "<positiveInt>", // R!  Information instance identifier
    "category" : { CodeableConcept }, // R!  Classification of the supplied information
    "subCategory" : { CodeableConcept }, // Finer-grained classification of the supplied information
    "code" : { CodeableConcept }, // Type of information
    // timing[x]: When it occurred. One of these 3:

    "timingDateTime" : "<dateTime>",
    "timingPeriod" : { Period },
    "timingTiming" : { Timing },
    // value[x]: Data to be provided. One of these 55:

    "valueBase64Binary" : "<base64Binary>",
    "valueBoolean" : <boolean>,
    "valueCanonical" : "<canonical>",
    "valueCode" : "<code>",
    "valueDate" : "<date>",
    "valueDateTime" : "<dateTime>",
    "valueDecimal" : <decimal>,
    "valueId" : "<id>",
    "valueInstant" : "<instant>",
    "valueInteger" : <integer>,
    "valueInteger64" : "<integer64>",
    "valueMarkdown" : "<markdown>",
    "valueOid" : "<oid>",
    "valuePositiveInt" : "<positiveInt>",
    "valueString" : "<string>",
    "valueTime" : "<time>",
    "valueUnsignedInt" : "<unsignedInt>",
    "valueUri" : "<uri>",
    "valueUrl" : "<url>",
    "valueUuid" : "<uuid>",
    "valueAddress" : { Address },
    "valueAge" : { Age },
    "valueAnnotation" : { Annotation },
    "valueAttachment" : { Attachment },
    "valueCodeableConcept" : { CodeableConcept },
    "valueCodeableReference" : { CodeableReference },
    "valueCoding" : { Coding },
    "valueContactPoint" : { ContactPoint },
    "valueCount" : { Count },
    "valueDistance" : { Distance },
    "valueDuration" : { Duration },
    "valueHumanName" : { HumanName },
    "valueIdentifier" : { Identifier },
    "valueMoney" : { Money },
    "valuePeriod" : { Period },
    "valueQuantity" : { Quantity },
    "valueRange" : { Range },
    "valueRatio" : { Ratio },
    "valueRatioRange" : { RatioRange },
    "valueReference" : { Reference },
    "valueSampledData" : { SampledData },
    "valueSignature" : { Signature },
    "valueTiming" : { Timing },
    "valueContactDetail" : { ContactDetail },
    "valueDataRequirement" : { DataRequirement },
    "valueExpression" : { Expression },
    "valueParameterDefinition" : { ParameterDefinition },
    "valueRelatedArtifact" : { RelatedArtifact },
    "valueTriggerDefinition" : { TriggerDefinition },
    "valueUsageContext" : { UsageContext },
    "valueAvailability" : { Availability },
    "valueExtendedContactDetail" : { ExtendedContactDetail },
    "valueVirtualServiceDetail" : { VirtualServiceDetail },
    "valueDosage" : { Dosage },
    "valueMeta" : { Meta },
    "reason" : { CodeableConcept } // Explanation for the information

  }],
  "
    "
    "
    
    " }
    " }

  "diagnosis" : [{ // Pertinent diagnosis information
    "sequence" : "<positiveInt>", // R!  Diagnosis instance identifier
    // diagnosis[x]: Nature of illness or problem. One of these 2:

    "diagnosisCodeableConcept" : { CodeableConcept },
    "diagnosisReference" : { Reference(Condition) },
    "type" : [{ CodeableConcept }], // Timing or nature of the diagnosis
    "onAdmission" : { CodeableConcept } // Present on admission

  }],
  "
    "
    "
    "
    "
    "
    "

  "procedure" : [{ // Clinical procedures performed
    "sequence" : "<positiveInt>", // R!  Procedure instance identifier
    "type" : [{ CodeableConcept }], // Category of Procedure
    "date" : "<dateTime>", // When the procedure was performed
    // procedure[x]: Specific clinical procedure. One of these 2:

    "procedureCodeableConcept" : { CodeableConcept },
    "procedureReference" : { Reference(Procedure) },
    "udi" : [{ Reference(Device) }] // Unique device identifier

  }],
  "
    "When the accident occurred
see information codes
see information codes
    "
    
    " }
    " }

  "insurance" : [{ // Patient insurance information
    "sequence" : "<positiveInt>", // R!  Insurance instance identifier
    "focal" : <boolean>, // R!  Coverage to be used for adjudication
    "identifier" : { Identifier }, // Pre-assigned Claim number
    "coverage" : { Reference(Coverage) }, // R!  Insurance information
    "businessArrangement" : "<string>", // Additional provider contract number
    "preAuthRef" : ["<string>"], // Prior authorization reference number
    "claimResponse" : { Reference(ClaimResponse) } // Adjudication results
  }],
  "accident" : { // Details of the event
    "date" : "<date>", // R!  When the incident occurred
    "type" : { CodeableConcept }, // The nature of the accident icon
    // location[x]: Where the event occurred. One of these 2:

    "locationAddress" : { Address },
    "locationReference" : { Reference(Location) }

  },
  "
  "
  "
    "
    "
    "
    "
    "
    "
    "
    "
    "
    "
    
    ">",
    " },
    
    " },
    " },
    " },
    "
    "
    "
    "
    "
    "
    "
    "
    "
      "
      "
      "
      "
      "
      "
      "
      "
      "
      "
      "
      "
        "
        "
        "
        "
        "
        "
        "
        "
        "
        "
        "

  "patientPaid" : { Money }, // Paid by the patient
  "item" : [{ // Product or service provided
    "sequence" : "<positiveInt>", // R!  Item instance identifier
    "traceNumber" : [{ Identifier }], // Number for tracking
    "subject" : { Reference(Group|Patient) }, // The recipient of the products and services
    "careTeamSequence" : ["<positiveInt>"], // Applicable careTeam members
    "diagnosisSequence" : ["<positiveInt>"], // Applicable diagnoses
    "procedureSequence" : ["<positiveInt>"], // Applicable procedures
    "informationSequence" : ["<positiveInt>"], // Applicable exception and supporting information
    "revenue" : { CodeableConcept }, // Revenue or cost center code
    "category" : { CodeableConcept }, // Benefit classification
    "productOrService" : { CodeableConcept }, // Billing, service, product, or drug code
    "productOrServiceEnd" : { CodeableConcept }, // End of a range of codes
    "request" : [{ Reference(DeviceRequest|MedicationRequest|NutritionOrder|
    ServiceRequest|VisionPrescription) }], // Request or Referral for Service

    "modifier" : [{ CodeableConcept }], // Product or service billing modifiers
    "programCode" : [{ CodeableConcept }], // Program the product or service is provided under
    // serviced[x]: Date or dates of service or product delivery. One of these 2:

    "servicedDate" : "<date>",
    "servicedPeriod" : { Period },
    // location[x]: Place of service or where product was supplied. One of these 3:

    "locationCodeableConcept" : { CodeableConcept },
    "locationAddress" : { Address },
    "locationReference" : { Reference(Location) },
    "patientPaid" : { Money }, // Paid by the patient
    "quantity" : { Quantity(SimpleQuantity) }, // Count of products or services
    "unitPrice" : { Money }, // Fee, charge or cost per item
    "factor" : <decimal>, // Price scaling factor
    "tax" : { Money }, // Total tax
    "net" : { Money }, // Total item cost
    "udi" : [{ Reference(Device) }], // Unique device identifier
    "bodySite" : [{ // Anatomical location
      "site" : [{ CodeableReference(BodyStructure) }], // R!  Location
      "subSite" : [{ CodeableConcept }] // Sub-location
    }],
    "encounter" : [{ Reference(Encounter) }], // Encounters associated with the listed treatments
    "detail" : [{ // Product or service provided
      "sequence" : "<positiveInt>", // R!  Item instance identifier
      "traceNumber" : [{ Identifier }], // Number for tracking
      "revenue" : { CodeableConcept }, // Revenue or cost center code
      "category" : { CodeableConcept }, // Benefit classification
      "productOrService" : { CodeableConcept }, // Billing, service, product, or drug code
      "productOrServiceEnd" : { CodeableConcept }, // End of a range of codes
      "modifier" : [{ CodeableConcept }], // Service/Product billing modifiers
      "programCode" : [{ CodeableConcept }], // Program the product or service is provided under
      "patientPaid" : { Money }, // Paid by the patient
      "quantity" : { Quantity(SimpleQuantity) }, // Count of products or services
      "unitPrice" : { Money }, // Fee, charge or cost per item
      "factor" : <decimal>, // Price scaling factor
      "tax" : { Money }, // Total tax
      "net" : { Money }, // Total item cost
      "udi" : [{ Reference(Device) }], // Unique device identifier
      "subDetail" : [{ // Product or service provided
        "sequence" : "<positiveInt>", // R!  Item instance identifier
        "traceNumber" : [{ Identifier }], // Number for tracking
        "revenue" : { CodeableConcept }, // Revenue or cost center code
        "category" : { CodeableConcept }, // Benefit classification
        "productOrService" : { CodeableConcept }, // Billing, service, product, or drug code
        "productOrServiceEnd" : { CodeableConcept }, // End of a range of codes
        "modifier" : [{ CodeableConcept }], // Service/Product billing modifiers
        "programCode" : [{ CodeableConcept }], // Program the product or service is provided under
        "patientPaid" : { Money }, // Paid by the patient
        "quantity" : { Quantity(SimpleQuantity) }, // Count of products or services
        "unitPrice" : { Money }, // Fee, charge or cost per item
        "factor" : <decimal>, // Price scaling factor
        "tax" : { Money }, // Total tax
        "net" : { Money }, // Total item cost
        "udi" : [{ Reference(Device) }] // Unique device identifier

      }]
    }]
  }],
  "

  "total" : { Money } // Total claim cost

}

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:;

[ a fhir:Claim;

  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from 
  # from 
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
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  fhir:
    fhir:
    fhir:
    fhir:
  ], ...;
  fhir:
  fhir:
  fhir:
    fhir:
    fhir:
    fhir:
  ];
  fhir:
  fhir:
  fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
  ], ...;
  fhir:
    fhir:
    fhir:
    fhir:
    # . One of these 2
      fhir: ]
      fhir: ]
    # . One of these 4
      fhir: ]
      fhir: ]
      fhir: ]
      fhir:) ]
    fhir:
  ], ...;
  fhir:
    fhir:
    # . One of these 2
      fhir: ]
      fhir:) ]
    fhir:
    fhir:
  ], ...;
  fhir:
    fhir:
    fhir:
    # . One of these 2
      fhir: ]
      fhir:) ]
  ], ...;
  fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
  ], ...;
  fhir:
    fhir:When the accident occurred
see information codes
see information codes
    fhir:
    # . One of these 2
      fhir: ]
      fhir:) ]
  ];
  fhir:
  fhir:
  fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    # . One of these 2
      fhir: ]
      fhir: ]
    # . One of these 3
      fhir: ]
      fhir: ]
      fhir:) ]
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
      fhir:
      fhir:
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      fhir:
      fhir:
        fhir:
        fhir:
        fhir:
        fhir:
        fhir:
        fhir:
        fhir:
        fhir:
        fhir:
        fhir:
        fhir:
      ], ...;
    ], ...;
  ], ...;
  fhir:

  # from Resource: fhir:id, fhir:meta, fhir:implicitRules, and fhir:language
  # from DomainResource: fhir:text, fhir:contained, fhir:extension, and fhir:modifierExtension
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Business Identifier for claim
  fhir:traceNumber  ( [ Identifier ] ... ) ; # 0..* Number for tracking
  fhir:status [ code ] ; # 1..1 active | cancelled | draft | entered-in-error
  fhir:statusReason [ string ] ; # 0..1 Reason for status change
  fhir:type [ CodeableConcept ] ; # 1..1 Category or discipline
  fhir:subType [ CodeableConcept ] ; # 0..1 More granular claim type
  fhir:use [ code ] ; # 1..1 claim | preauthorization | predetermination
  fhir:subject [ Reference(Group|Patient) ] ; # 1..1 The recipient(s) of the products and services
  fhir:billablePeriod [ Period ] ; # 0..1 Relevant time frame for the claim
  fhir:created [ dateTime ] ; # 1..1 Resource creation date
  fhir:enterer [ Reference(Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 0..1 Author of the claim
  fhir:insurer [ Reference(Organization) ] ; # 0..1 Target
  fhir:provider [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Party responsible for the claim
  fhir:priority [ CodeableConcept ] ; # 0..1 Desired processing urgency
  fhir:fundsReserve [ CodeableConcept ] ; # 0..1 For whom to reserve funds
  fhir:related ( [ # 0..* Prior or corollary claims
    fhir:claim [ Reference(Claim) ] ; # 0..1 Reference to the related claim
    fhir:relationship [ CodeableConcept ] ; # 0..1 How the reference claim is related
    fhir:reference [ Identifier ] ; # 0..1 File or case reference
  ] ... ) ;
  fhir:prescription [ Reference(DeviceRequest|MedicationRequest|ServiceRequest|VisionPrescription) ] ; # 0..1 Prescription authorizing services and products
  fhir:originalPrescription [ Reference(DeviceRequest|MedicationRequest|ServiceRequest|VisionPrescription) ] ; # 0..1 Original prescription if superseded by fulfiller
  fhir:payee [ # 0..1 Recipient of benefits payable
    fhir:type [ CodeableConcept ] ; # 1..1 Category of recipient
    fhir:party [ Reference(Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 0..1 Recipient reference
  ] ;
  fhir:referral [ Reference(ServiceRequest) ] ; # 0..1 Treatment referral
  fhir:encounter  ( [ Reference(Encounter) ] ... ) ; # 0..* Encounters associated with the listed treatments
  fhir:facility [ Reference(Location|Organization) ] ; # 0..1 Servicing facility
  fhir:diagnosisRelatedGroup [ CodeableConcept ] ; # 0..1 Package billing code
  fhir:event ( [ # 0..* Event information
    fhir:type [ CodeableConcept ] ; # 1..1 Specific event
    # when[x] : 1..1 Occurance date or period. One of these 2
      fhir:when [  a fhir:DateTime ; dateTime ]
      fhir:when [  a fhir:Period ; Period ]
  ] ... ) ;
  fhir:careTeam ( [ # 0..* Members of the care team
    fhir:sequence [ positiveInt ] ; # 1..1 Order of care team
    fhir:provider [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 1..1 Practitioner or organization
    fhir:role [ CodeableConcept ] ; # 0..1 Function within the team
    fhir:specialty [ CodeableConcept ] ; # 0..1 Practitioner or provider specialization
  ] ... ) ;
  fhir:supportingInfo ( [ # 0..* Supporting information
    fhir:sequence [ positiveInt ] ; # 1..1 Information instance identifier
    fhir:category [ CodeableConcept ] ; # 1..1 Classification of the supplied information
    fhir:subCategory [ CodeableConcept ] ; # 0..1 Finer-grained classification of the supplied information
    fhir:code [ CodeableConcept ] ; # 0..1 Type of information
    # timing[x] : 0..1 When it occurred. One of these 3
      fhir:timing [  a fhir:DateTime ; dateTime ]
      fhir:timing [  a fhir:Period ; Period ]
      fhir:timing [  a fhir:Timing ; Timing ]
    # value[x] : 0..1 Data to be provided. One of these 55
      fhir:value [  a fhir:Base64Binary ; base64Binary ]
      fhir:value [  a fhir:Boolean ; boolean ]
      fhir:value [  a fhir:Canonical ; canonical ]
      fhir:value [  a fhir:Code ; code ]
      fhir:value [  a fhir:Date ; date ]
      fhir:value [  a fhir:DateTime ; dateTime ]
      fhir:value [  a fhir:Decimal ; decimal ]
      fhir:value [  a fhir:Id ; id ]
      fhir:value [  a fhir:Instant ; instant ]
      fhir:value [  a fhir:Integer ; integer ]
      fhir:value [  a fhir:Integer64 ; integer64 ]
      fhir:value [  a fhir:Markdown ; markdown ]
      fhir:value [  a fhir:Oid ; oid ]
      fhir:value [  a fhir:PositiveInt ; positiveInt ]
      fhir:value [  a fhir:String ; string ]
      fhir:value [  a fhir:Time ; time ]
      fhir:value [  a fhir:UnsignedInt ; unsignedInt ]
      fhir:value [  a fhir:Uri ; uri ]
      fhir:value [  a fhir:Url ; url ]
      fhir:value [  a fhir:Uuid ; uuid ]
      fhir:value [  a fhir:Address ; Address ]
      fhir:value [  a fhir:Age ; Age ]
      fhir:value [  a fhir:Annotation ; Annotation ]
      fhir:value [  a fhir:Attachment ; Attachment ]
      fhir:value [  a fhir:CodeableConcept ; CodeableConcept ]
      fhir:value [  a fhir:CodeableReference ; CodeableReference ]
      fhir:value [  a fhir:Coding ; Coding ]
      fhir:value [  a fhir:ContactPoint ; ContactPoint ]
      fhir:value [  a fhir:Count ; Count ]
      fhir:value [  a fhir:Distance ; Distance ]
      fhir:value [  a fhir:Duration ; Duration ]
      fhir:value [  a fhir:HumanName ; HumanName ]
      fhir:value [  a fhir:Identifier ; Identifier ]
      fhir:value [  a fhir:Money ; Money ]
      fhir:value [  a fhir:Period ; Period ]
      fhir:value [  a fhir:Quantity ; Quantity ]
      fhir:value [  a fhir:Range ; Range ]
      fhir:value [  a fhir:Ratio ; Ratio ]
      fhir:value [  a fhir:RatioRange ; RatioRange ]
      fhir:value [  a fhir:Reference ; Reference ]
      fhir:value [  a fhir:SampledData ; SampledData ]
      fhir:value [  a fhir:Signature ; Signature ]
      fhir:value [  a fhir:Timing ; Timing ]
      fhir:value [  a fhir:ContactDetail ; ContactDetail ]
      fhir:value [  a fhir:DataRequirement ; DataRequirement ]
      fhir:value [  a fhir:Expression ; Expression ]
      fhir:value [  a fhir:ParameterDefinition ; ParameterDefinition ]
      fhir:value [  a fhir:RelatedArtifact ; RelatedArtifact ]
      fhir:value [  a fhir:TriggerDefinition ; TriggerDefinition ]
      fhir:value [  a fhir:UsageContext ; UsageContext ]
      fhir:value [  a fhir:Availability ; Availability ]
      fhir:value [  a fhir:ExtendedContactDetail ; ExtendedContactDetail ]
      fhir:value [  a fhir:VirtualServiceDetail ; VirtualServiceDetail ]
      fhir:value [  a fhir:Dosage ; Dosage ]
      fhir:value [  a fhir:Meta ; Meta ]
    fhir:reason [ CodeableConcept ] ; # 0..1 Explanation for the information
  ] ... ) ;
  fhir:diagnosis ( [ # 0..* Pertinent diagnosis information
    fhir:sequence [ positiveInt ] ; # 1..1 Diagnosis instance identifier
    # diagnosis[x] : 1..1 Nature of illness or problem. One of these 2
      fhir:diagnosis [  a fhir:CodeableConcept ; CodeableConcept ]
      fhir:diagnosis [  a fhir:Reference ; Reference(Condition) ]
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* Timing or nature of the diagnosis
    fhir:onAdmission [ CodeableConcept ] ; # 0..1 Present on admission
  ] ... ) ;
  fhir:procedure ( [ # 0..* Clinical procedures performed
    fhir:sequence [ positiveInt ] ; # 1..1 Procedure instance identifier
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* Category of Procedure
    fhir:date [ dateTime ] ; # 0..1 When the procedure was performed
    # procedure[x] : 1..1 Specific clinical procedure. One of these 2
      fhir:procedure [  a fhir:CodeableConcept ; CodeableConcept ]
      fhir:procedure [  a fhir:Reference ; Reference(Procedure) ]
    fhir:udi  ( [ Reference(Device) ] ... ) ; # 0..* Unique device identifier
  ] ... ) ;
  fhir:insurance ( [ # 0..* Patient insurance information
    fhir:sequence [ positiveInt ] ; # 1..1 Insurance instance identifier
    fhir:focal [ boolean ] ; # 1..1 Coverage to be used for adjudication
    fhir:identifier [ Identifier ] ; # 0..1 Pre-assigned Claim number
    fhir:coverage [ Reference(Coverage) ] ; # 1..1 Insurance information
    fhir:businessArrangement [ string ] ; # 0..1 Additional provider contract number
    fhir:preAuthRef  ( [ string ] ... ) ; # 0..* Prior authorization reference number
    fhir:claimResponse [ Reference(ClaimResponse) ] ; # 0..1 Adjudication results
  ] ... ) ;
  fhir:accident [ # 0..1 Details of the event
    fhir:date [ date ] ; # 1..1 When the incident occurred
    fhir:type [ CodeableConcept ] ; # 0..1 The nature of the accident
    # location[x] : 0..1 Where the event occurred. One of these 2
      fhir:location [  a fhir:Address ; Address ]
      fhir:location [  a fhir:Reference ; Reference(Location) ]
  ] ;
  fhir:patientPaid [ Money ] ; # 0..1 Paid by the patient
  fhir:item ( [ # 0..* Product or service provided
    fhir:sequence [ positiveInt ] ; # 1..1 Item instance identifier
    fhir:traceNumber  ( [ Identifier ] ... ) ; # 0..* Number for tracking
    fhir:subject [ Reference(Group|Patient) ] ; # 0..1 The recipient of the products and services
    fhir:careTeamSequence  ( [ positiveInt ] ... ) ; # 0..* Applicable careTeam members
    fhir:diagnosisSequence  ( [ positiveInt ] ... ) ; # 0..* Applicable diagnoses
    fhir:procedureSequence  ( [ positiveInt ] ... ) ; # 0..* Applicable procedures
    fhir:informationSequence  ( [ positiveInt ] ... ) ; # 0..* Applicable exception and supporting information
    fhir:revenue [ CodeableConcept ] ; # 0..1 Revenue or cost center code
    fhir:category [ CodeableConcept ] ; # 0..1 Benefit classification
    fhir:productOrService [ CodeableConcept ] ; # 0..1 Billing, service, product, or drug code
    fhir:productOrServiceEnd [ CodeableConcept ] ; # 0..1 End of a range of codes
    fhir:request  ( [ Reference(DeviceRequest|MedicationRequest|NutritionOrder|ServiceRequest|VisionPrescription) ] ... ) ; # 0..* Request or Referral for Service
    fhir:modifier  ( [ CodeableConcept ] ... ) ; # 0..* Product or service billing modifiers
    fhir:programCode  ( [ CodeableConcept ] ... ) ; # 0..* Program the product or service is provided under
    # serviced[x] : 0..1 Date or dates of service or product delivery. One of these 2
      fhir:serviced [  a fhir:Date ; date ]
      fhir:serviced [  a fhir:Period ; Period ]
    # location[x] : 0..1 Place of service or where product was supplied. One of these 3
      fhir:location [  a fhir:CodeableConcept ; CodeableConcept ]
      fhir:location [  a fhir:Address ; Address ]
      fhir:location [  a fhir:Reference ; Reference(Location) ]
    fhir:patientPaid [ Money ] ; # 0..1 Paid by the patient
    fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 Count of products or services
    fhir:unitPrice [ Money ] ; # 0..1 Fee, charge or cost per item
    fhir:factor [ decimal ] ; # 0..1 Price scaling factor
    fhir:tax [ Money ] ; # 0..1 Total tax
    fhir:net [ Money ] ; # 0..1 Total item cost
    fhir:udi  ( [ Reference(Device) ] ... ) ; # 0..* Unique device identifier
    fhir:bodySite ( [ # 0..* Anatomical location
      fhir:site  ( [ CodeableReference(BodyStructure) ] ... ) ; # 1..* Location
      fhir:subSite  ( [ CodeableConcept ] ... ) ; # 0..* Sub-location
    ] ... ) ;
    fhir:encounter  ( [ Reference(Encounter) ] ... ) ; # 0..* Encounters associated with the listed treatments
    fhir:detail ( [ # 0..* Product or service provided
      fhir:sequence [ positiveInt ] ; # 1..1 Item instance identifier
      fhir:traceNumber  ( [ Identifier ] ... ) ; # 0..* Number for tracking
      fhir:revenue [ CodeableConcept ] ; # 0..1 Revenue or cost center code
      fhir:category [ CodeableConcept ] ; # 0..1 Benefit classification
      fhir:productOrService [ CodeableConcept ] ; # 0..1 Billing, service, product, or drug code
      fhir:productOrServiceEnd [ CodeableConcept ] ; # 0..1 End of a range of codes
      fhir:modifier  ( [ CodeableConcept ] ... ) ; # 0..* Service/Product billing modifiers
      fhir:programCode  ( [ CodeableConcept ] ... ) ; # 0..* Program the product or service is provided under
      fhir:patientPaid [ Money ] ; # 0..1 Paid by the patient
      fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 Count of products or services
      fhir:unitPrice [ Money ] ; # 0..1 Fee, charge or cost per item
      fhir:factor [ decimal ] ; # 0..1 Price scaling factor
      fhir:tax [ Money ] ; # 0..1 Total tax
      fhir:net [ Money ] ; # 0..1 Total item cost
      fhir:udi  ( [ Reference(Device) ] ... ) ; # 0..* Unique device identifier
      fhir:subDetail ( [ # 0..* Product or service provided
        fhir:sequence [ positiveInt ] ; # 1..1 Item instance identifier
        fhir:traceNumber  ( [ Identifier ] ... ) ; # 0..* Number for tracking
        fhir:revenue [ CodeableConcept ] ; # 0..1 Revenue or cost center code
        fhir:category [ CodeableConcept ] ; # 0..1 Benefit classification
        fhir:productOrService [ CodeableConcept ] ; # 0..1 Billing, service, product, or drug code
        fhir:productOrServiceEnd [ CodeableConcept ] ; # 0..1 End of a range of codes
        fhir:modifier  ( [ CodeableConcept ] ... ) ; # 0..* Service/Product billing modifiers
        fhir:programCode  ( [ CodeableConcept ] ... ) ; # 0..* Program the product or service is provided under
        fhir:patientPaid [ Money ] ; # 0..1 Paid by the patient
        fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 Count of products or services
        fhir:unitPrice [ Money ] ; # 0..1 Fee, charge or cost per item
        fhir:factor [ decimal ] ; # 0..1 Price scaling factor
        fhir:tax [ Money ] ; # 0..1 Total tax
        fhir:net [ Money ] ; # 0..1 Total item cost
        fhir:udi  ( [ Reference(Device) ] ... ) ; # 0..* Unique device identifier
      ] ... ) ;
    ] ... ) ;
  ] ... ) ;
  fhir:total [ Money ] ; # 0..1 Total claim cost

]

Changes since DSTU2 from both R4 and R4B

Claim.status Added Element Claim.type Claim.use Change value set from http://hl7.org/fhir/ValueSet/claim-use-link to http://hl7.org/fhir/ValueSet/claim-use Claim.patient Min Cardinality changed from 1 to 0 Claim.item.unitPrice Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money Claim.item.detail.unitPrice Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money Claim.item.detail.net Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money Claim.item.detail.udi Max Cardinality changed from 1 to * Type changed from Coding to Reference(Device) Claim.item.detail.subDetail.unitPrice Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money Claim.item.detail.subDetail.net Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money Claim.item.detail.subDetail.udi Max Cardinality changed from 1 to * Type changed from Coding to Reference(Device)
Claim Min Cardinality changed from 1 to 0 Type changed from code to CodeableConcept Change value set from http://hl7.org/fhir/ValueSet/claim-type-link to http://hl7.org/fhir/ValueSet/claim-type
Claim.subType Claim.traceNumber
  • Added Element
Claim.billablePeriod Claim.statusReason
  • Added Element
Claim.insurer Claim.subject
  • Added Mandatory Element
Claim.priority Type changed from Coding to CodeableConcept Claim.fundsReserve Claim.enterer
  • Type changed from Coding to CodeableConcept Claim.related Added Element Claim.related.claim Added Element Claim.related.relationship Added Element Claim.related.reference Reference: Added Element Claim.prescription Remove Reference(MedicationOrder), Add Reference(MedicationRequest) Target Types Patient, RelatedPerson
Claim.originalPrescription Claim.provider
  • Type Min Cardinality changed from Reference(MedicationOrder) 1 to Reference(MedicationRequest) 0
Claim.payee.type Claim.priority
  • Min Cardinality changed from 0 to 1 Type changed from Coding to CodeableConcept Claim.payee.resourceType Added Element Claim.payee.party Added Element Claim.careTeam Added Element 0
Claim.careTeam.sequence Claim.prescription
  • Type Reference: Added Element Target Type ServiceRequest
Claim.careTeam.provider Claim.originalPrescription
  • Type Reference: Added Element Target Type ServiceRequest
Claim.careTeam.responsible Claim.encounter
  • Added Element
Claim.careTeam.role Claim.facility
  • Type Reference: Added Element Target Type Organization
Claim.careTeam.qualification Claim.diagnosisRelatedGroup
  • Added Element
Claim.information Claim.event
  • Added Element
Claim.information.sequence Claim.event.type
  • Added Mandatory Element
Claim.information.category Claim.event.when[x]
  • Added Mandatory Element
Claim.information.code Claim.careTeam.specialty
  • Added Element
Claim.information.timing[x] Claim.supportingInfo.subCategory
  • Added Element
Claim.information.value[x] Claim.supportingInfo.timing[x]
  • Added Element Add Types dateTime, Timing
    • Claim.information.reason
  • Added Element Remove Type date
Claim.diagnosis.diagnosis[x] Claim.supportingInfo.value[x]
  • Renamed from diagnosis to diagnosis[x] Remove Coding, Add Types base64Binary, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, CodeableConcept, Add Reference(Condition) Claim.diagnosis.type Added Element Claim.diagnosis.packageCode Added Element Claim.procedure Added Element Claim.procedure.sequence Added Element Claim.procedure.date Added Element Claim.procedure.procedure[x] Added Element Claim.insurance Added Element Claim.insurance.sequence Added Element Claim.insurance.focal Added Element Claim.insurance.coverage Added Element Claim.insurance.businessArrangement Added Element Claim.insurance.preAuthRef Added Element Claim.insurance.claimResponse Added Element CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Range, Ratio, RatioRange, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, VirtualServiceDetail, Dosage, Meta
Claim.accident Claim.insurance
  • Type Min Cardinality changed from date 1 to BackboneElement Claim.accident.date Added Element Claim.accident.type Added Element Claim.accident.location[x] Added Element Claim.employmentImpacted Added Element Claim.hospitalization Added Element Claim.item.careTeamLinkId Added Element Claim.item.procedureLinkId Added Element 0
Claim.item.informationLinkId Claim.patientPaid
  • Added Element
Claim.item.revenue Claim.item.traceNumber
  • Added Element
Claim.item.category Claim.item.subject
  • Added Element
Claim.item.service Claim.item.productOrService
  • Min Cardinality changed from 1 to 0
    • Type changed from Coding to CodeableConcept Claim.item.modifier Type changed from Coding to CodeableConcept
Claim.item.programCode Claim.item.productOrServiceEnd
  • Added Element
Claim.item.serviced[x] Claim.item.request
  • Added Element
Claim.item.location[x] Claim.item.patientPaid
  • Added Element
Claim.item.net Claim.item.tax
  • Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money Added Element
Claim.item.udi Claim.item.bodySite
  • Max Cardinality changed from 1 to *
  • Type changed from Coding to Reference(Device) Claim.item.bodySite Type changed from Coding to CodeableConcept Claim.item.subSite Type changed from Coding to CodeableConcept BackboneElement
Claim.item.encounter Claim.item.bodySite.site
  • Added Mandatory Element
Claim.item.detail.revenue Claim.item.bodySite.subSite
  • Added Element
Claim.item.detail.category Claim.item.detail.traceNumber
  • Added Element
Claim.item.detail.service Claim.item.detail.productOrService
  • Min Cardinality changed from 1 to 0
    • Type changed from Coding to CodeableConcept
Claim.item.detail.modifier Claim.item.detail.productOrServiceEnd
  • Added Element
Claim.item.detail.programCode Claim.item.detail.patientPaid
  • Added Element
Claim.item.detail.subDetail.revenue Claim.item.detail.tax
  • Added Element
Claim.item.detail.subDetail.category Claim.item.detail.subDetail.traceNumber
  • Added Element
Claim.item.detail.subDetail.service Claim.item.detail.subDetail.productOrService
  • Min Cardinality changed from 1 to 0
    • Type changed from Coding to CodeableConcept
Claim.item.detail.subDetail.modifier Claim.item.detail.subDetail.productOrServiceEnd
  • Added Element
Claim.item.detail.subDetail.programCode Claim.item.detail.subDetail.patientPaid
  • Added Element
Claim.total Claim.item.detail.subDetail.tax
  • Added Element
Claim.ruleset deleted Claim.originalRuleset deleted Claim.target deleted Claim.payee.provider deleted Claim.payee.organization deleted Claim.payee.person deleted Claim.condition deleted Claim.coverage deleted Claim.exception deleted Claim.school deleted Claim.accidentType deleted Claim.interventionException deleted Claim.item.type deleted Claim.item.provider deleted Claim.item.serviceDate deleted Claim.item.points deleted Claim.item.detail.type deleted Claim.item.detail.points deleted Claim.item.detail.subDetail.type Claim.patient
  • deleted Deleted
Claim.item.detail.subDetail.points Claim.careTeam.responsible
  • deleted Deleted
Claim.item.prosthesis Claim.careTeam.qualification
  • deleted Deleted
Claim.additionalMaterials Claim.diagnosis.packageCode
  • deleted Deleted
Claim.missingTeeth Claim.item.subSite
  • deleted Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON .

 

Alternate Additional definitions: Master Definition ( XML , + JSON ), , XML Schema / Schematron (for ) + JSON Schema , ShEx (for Turtle ) + see the extensions , the spreadsheet version & the dependency analysis

13.6.2.1 13.6.4.1 Terminology Bindings

Claim.payee.resourceType Claim.careTeam.role Claim.diagnosis.packageCode Claim.procedure.procedure[x] Claim.accident.type Claim.item.revenue Claim.item.detail.revenue Claim.item.detail.subDetail.revenue Claim.item.category Claim.item.location[x] Claim.item.bodySite Claim.item.subSite
Path Definition ValueSet Type Reference Documentation
Claim.status A code specifying the state of the resource instance. FinancialResourceStatusCodes Required Financial Resource

This value set includes Status Codes codes.

Claim.type The type or discipline-style of the claim ClaimTypeCodes Required Extensible Example

This value set includes Claim Type Codes codes.

Claim.subType A more granular claim typecode ExampleClaimSubTypeCodes Example Example

This value set includes sample Claim SubType Codes codes which are used to distinguish the claim types for example within type institutional there may be subtypes for emergency services, bed stay and transportation.

Claim.use Complete, proposed, exploratory, other Use Required Use

The purpose of the Claim: predetermination, preauthorization, claim.

Claim.priority The timeliness with which processing is required: STAT, normal, Deferred ProcessPriorityCodes Example Preferred Process Priority Codes

This value set includes the financial processing priority codes.

Claim.fundsReserve For whom funds are to be reserved: (Patient, Provider, None). FundsReservationCodes Example Preferred Funds Reservation Codes

This value set includes funds reservation type codes.

Claim.related.relationship Relationship of this claim to a related Claim ExampleRelatedClaimRelationshipCodes Example Example

This value set includes sample Related Claim Relationship Codes codes.

Claim.payee.type A ClaimPayeeTypeCodes (a valid code for the party to be reimbursed. from Payee Type Codes icon ) Example Claim

This value set includes sample Payee Type Codes codes.

Claim.diagnosisRelatedGroup The type of Claim payee Resource ExampleDiagnosisRelatedGroupCodes Example ClaimPayeeResourceType

This value set includes example Diagnosis Related Group codes.

Claim.event.type The role codes for the care team members. DatesTypeCodes (a valid code from Dates Event Type Codes ) Example

This value set includes sample Dates Type codes.

Claim.careTeam.role ClaimCareTeamRoleCodes Preferred

This value set includes sample Claim Care Team Role Codes codes.

Claim.careTeam.qualification Claim.careTeam.specialty Provider professional qualifications ExampleProviderQualificationCodes Example Example

This value set includes sample Provider Qualification Codes codes.

Claim.information.category Claim.supportingInfo.category ClaimInformationCategoryCodes Preferred The valuset used for additional information category

This value set includes sample Information Category codes.

Claim.supportingInfo.subCategory Example Claim Information Category Codes
Claim.information.code Claim.supportingInfo.code The valuset used for additional information codes. ExceptionCodes Example

This value set includes sample Exception Codes codes.

Claim.information.reason Claim.supportingInfo.reason Reason codes for the missing teeth MissingToothReasonCodes Example

This value set includes sample Missing Tooth Reason Codes codes.

Claim.diagnosis.diagnosis[x] ICD10 Diagnostic codes ICD10Codes (a valid code from ICD-10 icon ) Example

This value set includes sample ICD-10 Codes codes.

Claim.diagnosis.type ExampleDiagnosisTypeCodes Preferred The type of the diagnosis: admitting, principal, discharge

This value set includes example Diagnosis Type codes.

Claim.diagnosis.onAdmission ExampleDiagnosisOnAdmissionCodes Example Preferred Example

This value set includes example Diagnosis on Admission codes.

Claim.procedure.type ExampleProcedureTypeCodes Preferred

This value set includes example Procedure Type codes.

Claim.procedure.procedure[x] ICD10ProcedureCodes (a valid code from ICD-10 Procedure Codes ) Example

This value set includes sample ICD-10 Procedure codes.

Claim.accident.type ActIncidentCode icon Extensible The DRG

Set of codes associated with indicating the diagnosis type of incident or accident.

Claim.item.revenue ExampleRevenueCenterCodes Example

This value set includes sample Revenue Center codes.

Claim.item.category BenefitCategoryCodes Example Diagnosis Related Group Codes

This value set includes examples of Benefit Category codes.

Claim.item.productOrService ICD10 Procedure codes USCLSCodes Example

This value set includes a smattering of USCLS codes.

Claim.item.productOrServiceEnd ICD-10 Procedure Codes USCLSCodes Example

This value set includes a smattering of USCLS codes.

Claim.item.modifier ModifierTypeCodes Example Type of accident: work place, auto, etc.

This value set includes sample Modifier type codes.

Claim.item.programCode ExampleProgramReasonCodes Required Example

This value set includes sample Program Reason Span codes.

Claim.item.location[x] ActIncidentCode ExampleServicePlaceCodes Example

This value set includes a smattering of Service Place codes.

Claim.item.bodySite.site OralSiteCodes Example Codes for the revenue or cost centers supplying the service and/or products.

This value set includes a smattering of FDI oral site codes.

Claim.item.bodySite.subSite SurfaceCodes Example

This value set includes a smattering of FDI tooth surface codes.

Claim.item.detail.revenue ExampleRevenueCenterCodes Example

This value set includes sample Revenue Center Codes codes.

Claim.item.detail.category Claim.item.detail.subDetail.category Benefit subcategories such as: oral-basic, major, glasses BenefitCategoryCodes Example

This value set includes examples of Benefit SubCategory Codes Category codes.

Claim.item.service Claim.item.detail.service Claim.item.detail.subDetail.service Claim.item.detail.productOrService Allowable service and product codes USCLSCodes Example

This value set includes a smattering of USCLS codes.

Claim.item.detail.productOrServiceEnd USCLS Codes USCLSCodes Example

This value set includes a smattering of USCLS codes.

Claim.item.modifier Claim.item.detail.modifier Claim.item.detail.subDetail.modifier Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ModifierTypeCodes Example

This value set includes sample Modifier type Codes codes.

Claim.item.programCode Claim.item.detail.programCode Claim.item.detail.subDetail.programCode Program specific reason codes ExampleProgramReasonCodes Example Example

This value set includes sample Program Reason Codes Span codes.

Claim.item.detail.subDetail.revenue Place of service: pharmacy,school, prison, etc. ExampleRevenueCenterCodes Example

This value set includes sample Revenue Center codes.

Claim.item.detail.subDetail.category BenefitCategoryCodes Example Service Place Codes

This value set includes examples of Benefit Category codes.

Claim.item.detail.subDetail.productOrService The code for the teeth, quadrant, sextant and arch USCLSCodes Example Oral Site Codes

This value set includes a smattering of USCLS codes.

Claim.item.detail.subDetail.productOrServiceEnd USCLSCodes Example The code for the tooth surface and surface combinations

This value set includes a smattering of USCLS codes.

Claim.item.detail.subDetail.modifier ModifierTypeCodes Example

This value set includes sample Modifier type codes.

Claim.item.detail.subDetail.programCode Surface Codes ExampleProgramReasonCodes Example

This value set includes sample Program Reason Span codes.

13.6.5 Additional Information

The information presented in different backbone elements, such as .supportingInfo or .adjudication, has a different context based on the .category code presented in each, for example, adjudication occurrence may represent an amount paid by the patient while another may represent the amount paid to the provider.

Additionally, there are several places in the resource which point to other sections of the resource via the use of a .sequence number in the referred-to element and an . element Sequence in the referring element. Sequence numbers appear in such element as .careTeam referred to by .careTeamSequence,.diagnosis referred to by .diagnosisSequence,.procedure referred to by .procedureSequence,.supportingInfo referred to by .informationSequence and .item referred to by .itemSequence.

13.6.3 13.6.6 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource , and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
care-team reference Member of the CareTeam Claim.careTeam.provider
( Practitioner , Organization , PractitionerRole )
created date The creation date for the Claim Claim.created
detail-udi reference UDI associated with a line item, detail product or service Claim.item.detail.udi
( Device )
encounter reference Encounters associated with a billed line item Claim.item.encounter
( Encounter ) 		27 Resources
enterer reference The party responsible for the entry of the Claim Claim.enterer
( Practitioner , Patient , PractitionerRole , RelatedPerson )
facility reference Facility responsible for where the goods and products or services have been or will be provided Claim.facility
( Organization , Location )
group reference Group receiving the products or services Claim.subject.where(resolve() is Group) | Claim.item.subject.where(resolve() is Group)
( Group , Patient )
identifier token The primary identifier of the financial resource Claim.identifier 59 Resources
insurer reference The target payor/insurer payer/insurer for the Claim Claim.insurer
( Organization )
item-udi organization reference The reference to the providing organization UDI associated with a line item product or service Claim.organization Claim.item.udi
( Organization Device )
patient reference Patient receiving the products or services Claim.patient Claim.subject.where(resolve() is Patient) | Claim.item.subject.where(resolve() is Patient)
( Group , Patient ) 		61 Resources
payee reference The party receiving any payment for the Claim Claim.payee.party
( Practitioner , Organization , Patient , PractitionerRole , RelatedPerson )
priority token Processing priority requested Claim.priority
procedure-udi reference UDI associated with a procedure Claim.procedure.udi
( Device )
provider reference Provider responsible for the Claim Claim.provider
( Practitioner , Organization , PractitionerRole )
status token The status of the Claim instance. Claim.status
subdetail-udi reference UDI associated with a line item, detail, subdetail product or service Claim.item.detail.subDetail.udi
( Device )
subject reference Subject receiving the products or services Claim.subject | Claim.item.subject
( Group , Patient )
use token The kind of financial resource Claim.use