ShEx
statement
for
claimresponse
PREFIX fhir: <http://hl7.org/fhir/>
PREFIX fhirvs: <http://hl7.org/fhir/ValueSet/>
PREFIX xsd: <http://www.w3.org/2001/XMLSchema#>
BASE <http://hl7.org/fhir/shape/>
start=@<ClaimResponse> AND {fhir:nodeRole [fhir:treeRoot]}
# Remittance resource
<ClaimResponse> CLOSED {
a [fhir:ClaimResponse];
fhir:nodeRole [fhir:treeRoot]?;
fhir:Resource.id @<id>?; # Logical id of this artifact
fhir:Resource.meta @<Meta>?; # Metadata about the resource
fhir:Resource.implicitRules @<uri>?; # A set of rules under which this
# content was created
fhir:Resource.language @<code>?; # Language of the resource content
fhir:DomainResource.text @<Narrative>?; # Text summary of the resource, for
# human interpretation
fhir:DomainResource.contained @<Resource>*; # Contained, inline Resources
fhir:DomainResource.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:DomainResource.modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.identifier @<Identifier>*; # Response number
fhir:ClaimResponse.status @<code> AND
{fhir:value @fhirvs:fm-status}?; # active | cancelled | draft |
# entered-in-error
fhir:ClaimResponse.patient @<Reference>?; # The subject of the Products and
# Services
fhir:ClaimResponse.created @<dateTime>?; # Creation date
fhir:ClaimResponse.insurer @<Reference>?; # Insurance issuing organization
fhir:ClaimResponse.requestProvider @<Reference>?; # Responsible practitioner
fhir:ClaimResponse.requestOrganization @<Reference>?; # Responsible organization
fhir:ClaimResponse.request @<Reference>?; # Id of resource triggering
# adjudication
fhir:ClaimResponse.outcome @<CodeableConcept>?; # complete | error | partial
fhir:ClaimResponse.disposition @<string>?; # Disposition Message
fhir:ClaimResponse.payeeType @<CodeableConcept>?; # Party to be paid any benefits
# payable
fhir:ClaimResponse.item @<ClaimResponse.item>*; # Line items
fhir:ClaimResponse.addItem @<ClaimResponse.addItem>*; # Insurer added line items
fhir:ClaimResponse.error @<ClaimResponse.error>*; # Processing errors
fhir:ClaimResponse.totalCost @<Money>?; # Total Cost of service from the
# Claim
fhir:ClaimResponse.unallocDeductable @<Money>?; # Unallocated deductible
fhir:ClaimResponse.totalBenefit @<Money>?; # Total benefit payable for the Claim
fhir:ClaimResponse.payment @<ClaimResponse.payment>?; # Payment details, if paid
fhir:ClaimResponse.reserved @<Coding>?; # Funds reserved status
fhir:ClaimResponse.form @<CodeableConcept>?; # Printed Form Identifier
fhir:ClaimResponse.processNote @<ClaimResponse.processNote>*; # Processing notes
fhir:ClaimResponse.communicationRequest @<Reference>*; # Request for additional information
fhir:ClaimResponse.insurance @<ClaimResponse.insurance>*; # Insurance or medical plan
fhir:index xsd:integer? # Relative position in a list
}
# Insurance or medical plan
<ClaimResponse.insurance> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.insurance.sequence @<positiveInt>; # Service instance identifier
fhir:ClaimResponse.insurance.focal @<boolean>; # Is the focal Coverage
fhir:ClaimResponse.insurance.coverage @<Reference>; # Insurance information
fhir:ClaimResponse.insurance.businessArrangement @<string>?; # Business agreement
fhir:ClaimResponse.insurance.preAuthRef @<string>*; # Pre-Authorization/Determination
# Reference
fhir:ClaimResponse.insurance.claimResponse @<Reference>?; # Adjudication results
fhir:index xsd:integer? # Relative position in a list
}
# Line items
<ClaimResponse.item> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.item.sequenceLinkId @<positiveInt>; # Service instance
fhir:ClaimResponse.item.noteNumber @<positiveInt>*; # List of note numbers which apply
fhir:ClaimResponse.item.adjudication @<ClaimResponse.item.adjudication>*; # Adjudication details
fhir:ClaimResponse.item.detail @<ClaimResponse.item.detail>*; # Detail line items
fhir:index xsd:integer? # Relative position in a list
}
# Insurer added line items
<ClaimResponse.addItem> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.addItem.sequenceLinkId @<positiveInt>*; # Service instances
fhir:ClaimResponse.addItem.revenue @<CodeableConcept>?; # Revenue or cost center code
fhir:ClaimResponse.addItem.category @<CodeableConcept>?; # Type of service or product
fhir:ClaimResponse.addItem.service @<CodeableConcept>?; # Group, Service or Product
fhir:ClaimResponse.addItem.modifier @<CodeableConcept>*; # Service/Product billing modifiers
fhir:ClaimResponse.addItem.fee @<Money>?; # Professional fee or Product charge
fhir:ClaimResponse.addItem.noteNumber @<positiveInt>*; # List of note numbers which apply
fhir:ClaimResponse.addItem.adjudication @<ClaimResponse.item.adjudication>*; # Added items adjudication
fhir:ClaimResponse.addItem.detail @<ClaimResponse.addItem.detail>*; # Added items details
fhir:index xsd:integer? # Relative position in a list
}
# Processing notes
<ClaimResponse.processNote> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.processNote.number @<positiveInt>?; # Sequence Number for this note
fhir:ClaimResponse.processNote.type @<CodeableConcept>?; # display | print | printoper
fhir:ClaimResponse.processNote.text @<string>?; # Note explanatory text
fhir:ClaimResponse.processNote.language @<CodeableConcept>?; # Language if different from the
# resource
fhir:index xsd:integer? # Relative position in a list
}
# Payment details, if paid
<ClaimResponse.payment> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.payment.type @<CodeableConcept>?; # Partial or Complete
fhir:ClaimResponse.payment.adjustment @<Money>?; # Payment adjustment for non-Claim
# issues
fhir:ClaimResponse.payment.adjustmentReason @<CodeableConcept>?; # Explanation for the non-claim
# adjustment
fhir:ClaimResponse.payment.date @<date>?; # Expected data of Payment
fhir:ClaimResponse.payment.amount @<Money>?; # Payable amount after adjustment
fhir:ClaimResponse.payment.identifier @<Identifier>?; # Identifier of the payment
# instrument
fhir:index xsd:integer? # Relative position in a list
}
# Processing errors
<ClaimResponse.error> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.error.sequenceLinkId @<positiveInt>?; # Item sequence number
fhir:ClaimResponse.error.detailSequenceLinkId @<positiveInt>?; # Detail sequence number
fhir:ClaimResponse.error.subdetailSequenceLinkId @<positiveInt>?; # Subdetail sequence number
fhir:ClaimResponse.error.code @<CodeableConcept>; # Error code detailing processing
# issues
fhir:index xsd:integer? # Relative position in a list
}
# Detail line items
<ClaimResponse.item.detail> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.item.detail.sequenceLinkId @<positiveInt>; # Service instance
fhir:ClaimResponse.item.detail.noteNumber @<positiveInt>*; # List of note numbers which apply
fhir:ClaimResponse.item.detail.adjudication @<ClaimResponse.item.adjudication>*; # Detail level adjudication details
fhir:ClaimResponse.item.detail.subDetail @<ClaimResponse.item.detail.subDetail>*; # Subdetail line items
fhir:index xsd:integer? # Relative position in a list
}
# Adjudication details
<ClaimResponse.item.adjudication> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.item.adjudication.category @<CodeableConcept>; # Adjudication category such as
# co-pay, eligible, benefit, etc.
fhir:ClaimResponse.item.adjudication.reason @<CodeableConcept>?; # Explanation of Adjudication outcome
fhir:ClaimResponse.item.adjudication.amount @<Money>?; # Monetary amount
fhir:ClaimResponse.item.adjudication.value @<decimal>?; # Non-monetary value
fhir:index xsd:integer? # Relative position in a list
}
# Added items details
<ClaimResponse.addItem.detail> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.addItem.detail.revenue @<CodeableConcept>?; # Revenue or cost center code
fhir:ClaimResponse.addItem.detail.category @<CodeableConcept>?; # Type of service or product
fhir:ClaimResponse.addItem.detail.service @<CodeableConcept>?; # Service or Product
fhir:ClaimResponse.addItem.detail.modifier @<CodeableConcept>*; # Service/Product billing modifiers
fhir:ClaimResponse.addItem.detail.fee @<Money>?; # Professional fee or Product charge
fhir:ClaimResponse.addItem.detail.noteNumber @<positiveInt>*; # List of note numbers which apply
fhir:ClaimResponse.addItem.detail.adjudication @<ClaimResponse.item.adjudication>*; # Added items detail adjudication
fhir:index xsd:integer? # Relative position in a list
}
# Subdetail line items
<ClaimResponse.item.detail.subDetail> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.item.detail.subDetail.sequenceLinkId @<positiveInt>; # Service instance
fhir:ClaimResponse.item.detail.subDetail.noteNumber @<positiveInt>*; # List of note numbers which apply
fhir:ClaimResponse.item.detail.subDetail.adjudication @<ClaimResponse.item.adjudication>*; # Subdetail level adjudication
# details
fhir:index xsd:integer? # Relative position in a list
}
#---------------------- Data Types -------------------
# Primitive Type dateTime
<dateTime> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:gYear OR xsd:gYearMonth OR xsd:date OR xsd:dateTime?; # Primitive value for dateTime
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type date
<date> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:gYear OR xsd:gYearMonth OR xsd:date?; # Primitive value for date
fhir:index xsd:integer? # Relative position in a list
}
# Metadata about a resource
<Meta> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Meta.versionId @<id>?; # Version specific identifier
fhir:Meta.lastUpdated @<instant>?; # When the resource version last
# changed
fhir:Meta.profile @<uri>*; # Profiles this resource claims to
# conform to
fhir:Meta.security @<Coding>*; # Security Labels applied to this
# resource
fhir:Meta.tag @<Coding>*; # Tags applied to this resource
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type code
<code> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:string?; # Primitive value for code
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type string
<string> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:string MAXLENGTH 1048576?; # Primitive value for string
fhir:index xsd:integer? # Relative position in a list
}
# A reference from one resource to another
<Reference> CLOSED {
fhir:link IRI?;
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Reference.reference @<string>?; # Literal reference, Relative,
# internal or absolute URL
fhir:Reference.identifier @<Identifier>?; # Logical reference, when literal
# reference is not known
fhir:Reference.display @<string>?; # Text alternative for the resource
fhir:index xsd:integer? # Relative position in a list
}
# Base Resource
<Resource> {a .+;
fhir:Resource.id @<id>?; # Logical id of this artifact
fhir:Resource.meta @<Meta>?; # Metadata about the resource
fhir:Resource.implicitRules @<uri>?; # A set of rules under which this
# content was created
fhir:Resource.language @<code>?; # Language of the resource content
fhir:index xsd:integer?
}
# Primitive Type uri
<uri> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:string?; # Primitive value for uri
fhir:index xsd:integer? # Relative position in a list
}
# Optional Extensions Element
<Extension> CLOSED {
fhir:Element.id @<string>?;
fhir:Element.extension @<Extension>*;
fhir:Extension.url @<uri>;
(
fhir:Extension.valueBase64Binary @<base64Binary> |
fhir:Extension.valueBoolean @<boolean> |
fhir:Extension.valueCode @<code> |
fhir:Extension.valueDate @<date> |
fhir:Extension.valueDateTime @<dateTime> |
fhir:Extension.valueDecimal @<decimal> |
fhir:Extension.valueId @<id> |
fhir:Extension.valueInstant @<instant> |
fhir:Extension.valueInteger @<integer> |
fhir:Extension.valueMarkdown @<markdown> |
fhir:Extension.valueOid @<oid> |
fhir:Extension.valuePositiveInt @<positiveInt> |
fhir:Extension.valueString @<string> |
fhir:Extension.valueTime @<time> |
fhir:Extension.valueUnsignedInt @<unsignedInt> |
fhir:Extension.valueUri @<uri> |
fhir:Extension.valueAddress @<Address> |
fhir:Extension.valueAge @<Age> |
fhir:Extension.valueAnnotation @<Annotation> |
fhir:Extension.valueAttachment @<Attachment> |
fhir:Extension.valueCodeableConcept @<CodeableConcept> |
fhir:Extension.valueCoding @<Coding> |
fhir:Extension.valueContactPoint @<ContactPoint> |
fhir:Extension.valueCount @<Count> |
fhir:Extension.valueDistance @<Distance> |
fhir:Extension.valueDuration @<Duration> |
fhir:Extension.valueHumanName @<HumanName> |
fhir:Extension.valueIdentifier @<Identifier> |
fhir:Extension.valueMoney @<Money> |
fhir:Extension.valuePeriod @<Period> |
fhir:Extension.valueQuantity @<Quantity> |
fhir:Extension.valueRange @<Range> |
fhir:Extension.valueRatio @<Ratio> |
fhir:Extension.valueReference @<Reference> |
fhir:Extension.valueSampledData @<SampledData> |
fhir:Extension.valueSignature @<Signature> |
fhir:Extension.valueTiming @<Timing> |
fhir:Extension.valueMeta @<Meta>
)?;
fhir:index xsd:integer? # Relative position in a list
}
# An amount of economic utility in some recognized currency
<Money> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Quantity.value @<decimal>?; # Numerical value (with implicit
# precision)
fhir:Quantity.comparator @<code> AND
{fhir:value @fhirvs:quantity-comparator}?; # < | <= | >= | > - how to
# understand the value
fhir:Quantity.unit @<string>?; # Unit representation
fhir:Quantity.system @<uri>?; # System that defines coded unit form
fhir:Quantity.code @<code>?; # Coded form of the unit
fhir:index xsd:integer? # Relative position in a list
}
# An identifier intended for computation
<Identifier> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Identifier.use @<code> AND
{fhir:value @fhirvs:identifier-use}?; # usual | official | temp |
# secondary (If known)
fhir:Identifier.type @<CodeableConcept>?; # Description of identifier
fhir:Identifier.system @<uri>?; # The namespace for the identifier
# value
fhir:Identifier.value @<string>?; # The value that is unique
fhir:Identifier.period @<Period>?; # Time period when id is/was valid
# for use
fhir:Identifier.assigner @<Reference>?; # Organization that issued id (may
# be just text)
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type boolean
<boolean> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:boolean?; # Primitive value for boolean
fhir:index xsd:integer? # Relative position in a list
}
# A human-readable formatted text, including images
<Narrative> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Narrative.status @<code> AND
{fhir:value @fhirvs:narrative-status}; # generated | extensions |
# additional | empty
fhir:Narrative.div xsd:string; # Limited xhtml content
fhir:index xsd:integer? # Relative position in a list
}
# A reference to a code defined by a terminology system
<Coding> CLOSED {
a NONLITERAL?;
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Coding.system @<uri>?; # Identity of the terminology system
fhir:Coding.version @<string>?; # Version of the system - if relevant
fhir:Coding.code @<code>?; # Symbol in syntax defined by the
# system
fhir:Coding.display @<string>?; # Representation defined by the
# system
fhir:Coding.userSelected @<boolean>?; # If this coding was chosen directly
# by the user
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type id
<id> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:string?; # Primitive value for id
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type positiveInt
<positiveInt> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:positiveInteger?; # Primitive value for positiveInt
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type decimal
<decimal> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:decimal?; # Primitive value for decimal
fhir:index xsd:integer? # Relative position in a list
}
# Concept - reference to a terminology or just text
<CodeableConcept> CLOSED {
a NONLITERAL*;
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:CodeableConcept.coding @<Coding>*; # Code defined by a terminology
# system
fhir:CodeableConcept.text @<string>?; # Plain text representation of the
# concept
fhir:index xsd:integer? # Relative position in a list
}
# An address expressed using postal conventions (as opposed to GPS or other location definition formats)
<Address> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Address.use @<code> AND
{fhir:value @fhirvs:address-use}?; # home | work | temp | old - purpose
# of this address
fhir:Address.type @<code> AND
{fhir:value @fhirvs:address-type}?; # postal | physical | both
fhir:Address.text @<string>?; # Text representation of the address
fhir:Address.line @<string>*; # Street name, number, direction &
# P.O. Box etc.
fhir:Address.city @<string>?; # Name of city, town etc.
fhir:Address.district @<string>?; # District name (aka county)
fhir:Address.state @<string>?; # Sub-unit of country (abbreviations
# ok)
fhir:Address.postalCode @<string>?; # Postal code for area
fhir:Address.country @<string>?; # Country (e.g. can be ISO 3166 2 or
# 3 letter code)
fhir:Address.period @<Period>?; # Time period when address was/is in
# use
fhir:index xsd:integer? # Relative position in a list
}
# Content in a format defined elsewhere
<Attachment> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Attachment.contentType @<code>?; # Mime type of the content, with
# charset etc.
fhir:Attachment.language @<code>?; # Human language of the content
# (BCP-47)
fhir:Attachment.data @<base64Binary>?; # Data inline, base64ed
fhir:Attachment.url @<uri>?; # Uri where the data can be found
fhir:Attachment.size @<unsignedInt>?; # Number of bytes of content (if url
# provided)
fhir:Attachment.hash @<base64Binary>?; # Hash of the data (sha-1, base64ed)
fhir:Attachment.title @<string>?; # Label to display in place of the
# data
fhir:Attachment.creation @<dateTime>?; # Date attachment was first created
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type integer
<integer> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:integer MININCLUSIVE "-2147483648"^^xsd:integer MAXINCLUSIVE "2147483647"^^xsd:integer?; # Primitive value for integer
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type oid
<oid> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:string?; # Primitive value for oid
fhir:index xsd:integer? # Relative position in a list
}
# A measured or measurable amount
<Count> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Quantity.value @<decimal>?; # Numerical value (with implicit
# precision)
fhir:Quantity.comparator @<code> AND
{fhir:value @fhirvs:quantity-comparator}?; # < | <= | >= | > - how to
# understand the value
fhir:Quantity.unit @<string>?; # Unit representation
fhir:Quantity.system @<uri>?; # System that defines coded unit form
fhir:Quantity.code @<code>?; # Coded form of the unit
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type instant
<instant> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:dateTime?; # Primitive value for instant
fhir:index xsd:integer? # Relative position in a list
}
# Details of a Technology mediated contact point (phone, fax, email, etc.)
<ContactPoint> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:ContactPoint.system @<code> AND
{fhir:value @fhirvs:contact-point-system}?; # phone | fax | email | pager | url
# | sms | other
fhir:ContactPoint.value @<string>?; # The actual contact point details
fhir:ContactPoint.use @<code> AND
{fhir:value @fhirvs:contact-point-use}?; # home | work | temp | old | mobile
# - purpose of this contact point
fhir:ContactPoint.rank @<positiveInt>?; # Specify preferred order of use (1
# = highest)
fhir:ContactPoint.period @<Period>?; # Time period when the contact point
# was/is in use
fhir:index xsd:integer? # Relative position in a list
}
# Name of a human - parts and usage
<HumanName> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:HumanName.use @<code> AND
{fhir:value @fhirvs:name-use}?; # usual | official | temp | nickname
# | anonymous | old | maiden
fhir:HumanName.text @<string>?; # Text representation of the full
# name
fhir:HumanName.family @<string>?; # Family name (often called
# 'Surname')
fhir:HumanName.given @<string>*; # Given names (not always 'first').
# Includes middle names
fhir:HumanName.prefix @<string>*; # Parts that come before the name
fhir:HumanName.suffix @<string>*; # Parts that come after the name
fhir:HumanName.period @<Period>?; # Time period when name was/is in use
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type markdown
<markdown> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:string?; # Primitive value for markdown
fhir:index xsd:integer? # Relative position in a list
}
# A series of measurements taken by a device
<SampledData> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:SampledData.origin @<SimpleQuantity>; # Zero value and units
fhir:SampledData.period @<decimal>; # Number of milliseconds between
# samples
fhir:SampledData.factor @<decimal>?; # Multiply data by this before
# adding to origin
fhir:SampledData.lowerLimit @<decimal>?; # Lower limit of detection
fhir:SampledData.upperLimit @<decimal>?; # Upper limit of detection
fhir:SampledData.dimensions @<positiveInt>; # Number of sample points at each
# time point
fhir:SampledData.data @<string>; # Decimal values with spaces, or "E"
# | "U" | "L"
fhir:index xsd:integer? # Relative position in a list
}
# A ratio of two Quantity values - a numerator and a denominator
<Ratio> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Ratio.numerator @<Quantity>?; # Numerator value
fhir:Ratio.denominator @<Quantity>?; # Denominator value
fhir:index xsd:integer? # Relative position in a list
}
# A duration of time during which an organism (or a process) has existed
<Age> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Quantity.value @<decimal>?; # Numerical value (with implicit
# precision)
fhir:Quantity.comparator @<code> AND
{fhir:value @fhirvs:quantity-comparator}?; # < | <= | >= | > - how to
# understand the value
fhir:Quantity.unit @<string>?; # Unit representation
fhir:Quantity.system @<uri>?; # System that defines coded unit form
fhir:Quantity.code @<code>?; # Coded form of the unit
fhir:index xsd:integer? # Relative position in a list
}
# A length - a value with a unit that is a physical distance
<Distance> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Quantity.value @<decimal>?; # Numerical value (with implicit
# precision)
fhir:Quantity.comparator @<code> AND
{fhir:value @fhirvs:quantity-comparator}?; # < | <= | >= | > - how to
# understand the value
fhir:Quantity.unit @<string>?; # Unit representation
fhir:Quantity.system @<uri>?; # System that defines coded unit form
fhir:Quantity.code @<code>?; # Coded form of the unit
fhir:index xsd:integer? # Relative position in a list
}
# Time range defined by start and end date/time
<Period> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Period.start @<dateTime>?; # Starting time with inclusive
# boundary
fhir:Period.end @<dateTime>?; # End time with inclusive boundary,
# if not ongoing
fhir:index xsd:integer? # Relative position in a list
}
# A measured or measurable amount
<Quantity> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Quantity.value @<decimal>?; # Numerical value (with implicit
# precision)
fhir:Quantity.comparator @<code> AND
{fhir:value @fhirvs:quantity-comparator}?; # < | <= | >= | > - how to
# understand the value
fhir:Quantity.unit @<string>?; # Unit representation
fhir:Quantity.system @<uri>?; # System that defines coded unit form
fhir:Quantity.code @<code>?; # Coded form of the unit
fhir:index xsd:integer? # Relative position in a list
}
# A length of time
<Duration> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Quantity.value @<decimal>?; # Numerical value (with implicit
# precision)
fhir:Quantity.comparator @<code> AND
{fhir:value @fhirvs:quantity-comparator}?; # < | <= | >= | > - how to
# understand the value
fhir:Quantity.unit @<string>?; # Unit representation
fhir:Quantity.system @<uri>?; # System that defines coded unit form
fhir:Quantity.code @<code>?; # Coded form of the unit
fhir:index xsd:integer? # Relative position in a list
}
# Set of values bounded by low and high
<Range> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Range.low @<SimpleQuantity>?; # Low limit
fhir:Range.high @<SimpleQuantity>?; # High limit
fhir:index xsd:integer? # Relative position in a list
}
# Text node with attribution
<Annotation> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
( # Individual responsible for the
# annotation
fhir:Annotation.authorReference @<Reference> |
fhir:Annotation.authorReference @<Reference> |
fhir:Annotation.authorReference @<Reference> |
fhir:Annotation.authorString @<string>
)?;
fhir:Annotation.time @<dateTime>?; # When the annotation was made
fhir:Annotation.text @<string>; # The annotation - text content
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type base64Binary
<base64Binary> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:base64Binary?; # Primitive value for base64Binary
fhir:index xsd:integer? # Relative position in a list
}
# A digital Signature - XML DigSig, JWT, Graphical image of signature, etc.
<Signature> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Signature.type @<Coding>+; # Indication of the reason the
# entity signed the object(s)
fhir:Signature.when @<instant>; # When the signature was created
( # Who signed
fhir:Signature.whoUri @<uri> |
fhir:Signature.whoReference @<Reference> |
fhir:Signature.whoReference @<Reference> |
fhir:Signature.whoReference @<Reference> |
fhir:Signature.whoReference @<Reference> |
fhir:Signature.whoReference @<Reference>
);
( # The party represented
fhir:Signature.onBehalfOfUri @<uri> |
fhir:Signature.onBehalfOfReference @<Reference> |
fhir:Signature.onBehalfOfReference @<Reference> |
fhir:Signature.onBehalfOfReference @<Reference> |
fhir:Signature.onBehalfOfReference @<Reference> |
fhir:Signature.onBehalfOfReference @<Reference>
)?;
fhir:Signature.contentType @<code>?; # The technical format of the
# signature
fhir:Signature.blob @<base64Binary>?; # The actual signature content (XML
# DigSig. JWT, picture, etc.)
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type unsignedInt
<unsignedInt> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:nonNegativeInteger?; # Primitive value for unsignedInt
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type time
<time> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:time?; # Primitive value for time
fhir:index xsd:integer? # Relative position in a list
}
# A timing schedule that specifies an event that may occur multiple times
<Timing> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Timing.event @<dateTime>*; # When the event occurs
fhir:Timing.repeat @<Timing.repeat>?; # When the event is to occur
fhir:Timing.code @<CodeableConcept>?; # BID | TID | QID | AM | PM | QD |
# QOD | Q4H | Q6H +
fhir:index xsd:integer? # Relative position in a list
}
# A fixed quantity (no comparator)
<SimpleQuantity> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Quantity.value @<decimal>?; # Numerical value (with implicit
# precision)
fhir:Quantity.unit @<string>?; # Unit representation
fhir:Quantity.system @<uri>?; # System that defines coded unit form
fhir:Quantity.code @<code>?; # Coded form of the unit
fhir:index xsd:integer? # Relative position in a list
}
# When the event is to occur
<Timing.repeat> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:Element.extension @<Extension>*; # Additional Content defined by
# implementations
( # Length/Range of lengths, or (Start
# and/or end) limits
fhir:Timing.repeat.boundsDuration @<Duration> |
fhir:Timing.repeat.boundsRange @<Range> |
fhir:Timing.repeat.boundsPeriod @<Period>
)?;
fhir:Timing.repeat.count @<integer>?; # Number of times to repeat
fhir:Timing.repeat.countMax @<integer>?; # Maximum number of times to repeat
fhir:Timing.repeat.duration @<decimal>?; # How long when it happens
fhir:Timing.repeat.durationMax @<decimal>?; # How long when it happens (Max)
fhir:Timing.repeat.durationUnit @<code> AND
{fhir:value @fhirvs:units-of-time}?; # s | min | h | d | wk | mo | a -
# unit of time (UCUM)
fhir:Timing.repeat.frequency @<integer>?; # Event occurs frequency times per
# period
fhir:Timing.repeat.frequencyMax @<integer>?; # Event occurs up to frequencyMax
# times per period
fhir:Timing.repeat.period @<decimal>?; # Event occurs frequency times per
# period
fhir:Timing.repeat.periodMax @<decimal>?; # Upper limit of period (3-4 hours)
fhir:Timing.repeat.periodUnit @<code> AND
{fhir:value @fhirvs:units-of-time}?; # s | min | h | d | wk | mo | a -
# unit of time (UCUM)
fhir:Timing.repeat.dayOfWeek @<code> AND
{fhir:value @fhirvs:days-of-week}*; # mon | tue | wed | thu | fri | sat
# | sun
fhir:Timing.repeat.timeOfDay @<time>*; # Time of day for action
fhir:Timing.repeat.when @<code> AND
{fhir:value @fhirvs:event-timing}*; # Regular life events the event is
# tied to
fhir:Timing.repeat.offset @<unsignedInt>?; # Minutes from event (before or
# after)
fhir:index xsd:integer? # Relative position in a list
}
#---------------------- Reference Types -------------------
#---------------------- Value Sets ------------------------
# The status of a resource narrative
fhirvs:narrative-status ["generated" "extensions" "additional" "empty"]
# The type of an address (physical / postal)
fhirvs:address-type ["postal" "physical" "both"]
# Use of contact point
fhirvs:contact-point-use ["home" "work" "temp" "old" "mobile"]
# Real world event relating to the schedule.
fhirvs:event-timing ["MORN" "AFT" "EVE" "NIGHT" "PHS" "HS" "WAKE" "C" "CM" "CD" "CV" "AC" "ACM" "ACD" "ACV" "PC" "PCM" "PCD" "PCV"]
# The days of the week.
fhirvs:days-of-week ["mon" "tue" "wed" "thu" "fri" "sat" "sun"]
# Identifies the purpose for this identifier, if known .
fhirvs:identifier-use ["usual" "official" "temp" "secondary"]
# A unit of time (units from UCUM).
fhirvs:units-of-time ["s" "min" "h" "d" "wk" "mo" "a"]
# The use of an address
fhirvs:address-use ["home" "work" "temp" "old"]
# The use of a human name
fhirvs:name-use ["usual" "official" "temp" "nickname" "anonymous" "old" "maiden"]
# How the Quantity should be understood and represented.
fhirvs:quantity-comparator ["<" "<=" ">=" ">"]
# Telecommunications form for contact point
fhirvs:contact-point-system ["phone" "fax" "email" "pager" "url" "sms" "other"]
# This value set includes Status codes.
fhirvs:fm-status ["active" "cancelled" "draft" "entered-in-error"]
PREFIX fhir: <http://hl7.org/fhir/>
PREFIX fhirvs: <http://hl7.org/fhir/ValueSet/>
PREFIX xsd: <http://www.w3.org/2001/XMLSchema#>
PREFIX rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#>
# ShEx Version 2.2
IMPORT <Id.shex>
IMPORT <Oid.shex>
IMPORT <Uri.shex>
IMPORT <Url.shex>
IMPORT <Age.shex>
IMPORT <Code.shex>
IMPORT <Date.shex>
IMPORT <Time.shex>
IMPORT <Uuid.shex>
IMPORT <Meta.shex>
IMPORT <Group.shex>
IMPORT <Claim.shex>
IMPORT <Money.shex>
IMPORT <Count.shex>
IMPORT <Range.shex>
IMPORT <Ratio.shex>
IMPORT <String.shex>
IMPORT <Period.shex>
IMPORT <Timing.shex>
IMPORT <Coding.shex>
IMPORT <Dosage.shex>
IMPORT <Patient.shex>
IMPORT <Decimal.shex>
IMPORT <Boolean.shex>
IMPORT <Instant.shex>
IMPORT <Integer.shex>
IMPORT <Address.shex>
IMPORT <DateTime.shex>
IMPORT <Quantity.shex>
IMPORT <Markdown.shex>
IMPORT <Coverage.shex>
IMPORT <Distance.shex>
IMPORT <Duration.shex>
IMPORT <Location.shex>
IMPORT <Reference.shex>
IMPORT <Canonical.shex>
IMPORT <Integer64.shex>
IMPORT <HumanName.shex>
IMPORT <Signature.shex>
IMPORT <Encounter.shex>
IMPORT <Identifier.shex>
IMPORT <Attachment.shex>
IMPORT <Annotation.shex>
IMPORT <RatioRange.shex>
IMPORT <Expression.shex>
IMPORT <PositiveInt.shex>
IMPORT <UnsignedInt.shex>
IMPORT <SampledData.shex>
IMPORT <Organization.shex>
IMPORT <Practitioner.shex>
IMPORT <Base64Binary.shex>
IMPORT <ContactPoint.shex>
IMPORT <UsageContext.shex>
IMPORT <Availability.shex>
IMPORT <ContactDetail.shex>
IMPORT <DeviceRequest.shex>
IMPORT <DomainResource.shex>
IMPORT <NutritionOrder.shex>
IMPORT <ServiceRequest.shex>
IMPORT <CodeableConcept.shex>
IMPORT <BackboneElement.shex>
IMPORT <DataRequirement.shex>
IMPORT <RelatedArtifact.shex>
IMPORT <PractitionerRole.shex>
IMPORT <CodeableReference.shex>
IMPORT <TriggerDefinition.shex>
IMPORT <MedicationRequest.shex>
IMPORT <VisionPrescription.shex>
IMPORT <ParameterDefinition.shex>
IMPORT <VirtualServiceDetail.shex>
IMPORT <CommunicationRequest.shex>
IMPORT <ExtendedContactDetail.shex>
start=@<ClaimResponse> AND {fhir:nodeRole [fhir:treeRoot]}
# Response to a claim predetermination or preauthorization
<ClaimResponse> EXTENDS @<DomainResource> CLOSED {
a [fhir:ClaimResponse]?;fhir:nodeRole [fhir:treeRoot]?;
fhir:identifier @<OneOrMore_Identifier>?; # Business Identifier for a claim
# response
fhir:traceNumber @<OneOrMore_Identifier>?; # Number for tracking
fhir:status @<Code> AND
{fhir:v @fhirvs:fm-status}; # active | cancelled | draft |
# entered-in-error
fhir:statusReason @<String>?; # Reason for status change
fhir:type @<CodeableConcept>; # More granular claim type
fhir:subType @<CodeableConcept>?; # More granular claim type
fhir:use @<Code> AND
{fhir:v @fhirvs:claim-use}; # claim | preauthorization |
# predetermination
fhir:subject @<Reference> AND {fhir:l
@<Group> OR
@<Patient> ? }; # The recipient(s) of the products
# and services
fhir:created @<DateTime>; # Response creation date
fhir:insurer @<Reference> AND {fhir:l
@<Organization> ? }?; # Party responsible for reimbursement
fhir:requestor @<Reference> AND {fhir:l
@<Organization> OR
@<Practitioner> OR
@<PractitionerRole> ? }?; # Party responsible for the claim
fhir:request @<Reference> AND {fhir:l
@<Claim> ? }?; # Id of resource triggering
# adjudication
fhir:outcome @<Code> AND
{fhir:v @fhirvs:claim-outcome}; # queued | complete | error | partial
fhir:decision @<CodeableConcept>?; # Result of the adjudication
fhir:disposition @<String>?; # Disposition Message
fhir:preAuthRef @<String>?; # Preauthorization reference
fhir:preAuthPeriod @<Period>?; # Preauthorization reference
# effective period
fhir:event @<OneOrMore_ClaimResponse.event>?; # Event information
fhir:payeeType @<CodeableConcept>?; # Party to be paid any benefits
# payable
fhir:encounter @<OneOrMore_Reference_Encounter>?; # Encounters associated with the
# listed treatments
fhir:diagnosisRelatedGroup @<CodeableConcept>?; # Package billing code
fhir:supportingInfo @<OneOrMore_ClaimResponse.supportingInfo>?; # Supporting information
fhir:item @<OneOrMore_ClaimResponse.item>?; # Adjudication for claim line items
fhir:addItem @<OneOrMore_ClaimResponse.addItem>?; # Insurer added line items
fhir:adjudication @<OneOrMore_ClaimResponse.item.adjudication>?; # Header-level adjudication
fhir:total @<OneOrMore_ClaimResponse.total>?; # Adjudication totals
fhir:payment @<ClaimResponse.payment>?; # Payment Details
fhir:fundsReserve @<CodeableConcept>?; # Funds reserved status
fhir:formCode @<CodeableConcept>?; # Printed form identifier
fhir:form @<Attachment>?; # Printed reference or actual form
fhir:processNote @<OneOrMore_ClaimResponse.processNote>?; # Note concerning adjudication
fhir:communicationRequest @<OneOrMore_Reference_CommunicationRequest>?; # Request for additional information
fhir:insurance @<OneOrMore_ClaimResponse.insurance>?; # Patient insurance information
fhir:error @<OneOrMore_ClaimResponse.error>?; # Processing errors
}
# Adjudication for claim line items
<ClaimResponse.item> EXTENDS @<BackboneElement> CLOSED {
fhir:itemSequence @<PositiveInt>; # Claim item instance identifier
fhir:traceNumber @<OneOrMore_Identifier>?; # Number for tracking
fhir:informationSequence @<OneOrMore_PositiveInt>?; # Applicable exception and
# supporting information
fhir:noteNumber @<OneOrMore_PositiveInt>?; # Applicable note numbers
fhir:reviewOutcome @<ClaimResponse.item.reviewOutcome>?; # Adjudication results
fhir:adjudication @<OneOrMore_ClaimResponse.item.adjudication>?; # Adjudication details
fhir:detail @<OneOrMore_ClaimResponse.item.detail>?; # Adjudication for claim details
}
# Insurer added line items
<ClaimResponse.addItem.detail.subDetail> EXTENDS @<BackboneElement> CLOSED {
fhir:traceNumber @<OneOrMore_Identifier>?; # Number for tracking
fhir:revenue @<CodeableConcept>?; # Revenue or cost center code
fhir:productOrService @<CodeableConcept>?; # Billing, service, product, or drug
# code
fhir:productOrServiceEnd @<CodeableConcept>?; # End of a range of codes
fhir:modifier @<OneOrMore_CodeableConcept>?; # Service/Product billing modifiers
fhir:quantity @<Quantity>?; # Count of products or services
fhir:unitPrice @<Money>?; # Fee, charge or cost per item
fhir:factor @<Decimal>?; # Price scaling factor
fhir:tax @<Money>?; # Total tax
fhir:net @<Money>?; # Total item cost
fhir:noteNumber @<OneOrMore_PositiveInt>?; # Applicable note numbers
fhir:reviewOutcome @<ClaimResponse.item.reviewOutcome>?; # Added items subdetail level
# adjudication results
fhir:adjudication @<OneOrMore_ClaimResponse.item.adjudication>?; # Added items subdetail adjudication
}
# Note concerning adjudication
<ClaimResponse.processNote> EXTENDS @<BackboneElement> CLOSED {
fhir:class @<CodeableConcept>?; # Business kind of note
fhir:number @<PositiveInt>?; # Note instance identifier
fhir:type @<CodeableConcept>?; # Note purpose
fhir:text @<Markdown>; # Note explanatory text
fhir:language @<CodeableConcept>?; # Language of the text
}
# Insurer added line details
<ClaimResponse.addItem.detail> EXTENDS @<BackboneElement> CLOSED {
fhir:traceNumber @<OneOrMore_Identifier>?; # Number for tracking
fhir:revenue @<CodeableConcept>?; # Revenue or cost center code
fhir:productOrService @<CodeableConcept>?; # Billing, service, product, or drug
# code
fhir:productOrServiceEnd @<CodeableConcept>?; # End of a range of codes
fhir:modifier @<OneOrMore_CodeableConcept>?; # Service/Product billing modifiers
fhir:quantity @<Quantity>?; # Count of products or services
fhir:unitPrice @<Money>?; # Fee, charge or cost per item
fhir:factor @<Decimal>?; # Price scaling factor
fhir:tax @<Money>?; # Total tax
fhir:net @<Money>?; # Total item cost
fhir:noteNumber @<OneOrMore_PositiveInt>?; # Applicable note numbers
fhir:reviewOutcome @<ClaimResponse.item.reviewOutcome>?; # Added items detail level
# adjudication results
fhir:adjudication @<OneOrMore_ClaimResponse.item.adjudication>?; # Added items detail adjudication
fhir:subDetail @<OneOrMore_ClaimResponse.addItem.detail.subDetail>?; # Insurer added line items
}
# Anatomical location
<ClaimResponse.addItem.bodySite> EXTENDS @<BackboneElement> CLOSED {
fhir:site @<OneOrMore_CodeableReference>; # Location
fhir:subSite @<OneOrMore_CodeableConcept>?; # Sub-location
}
# Payment Details
<ClaimResponse.payment> EXTENDS @<BackboneElement> CLOSED {
fhir:type @<CodeableConcept>; # Partial or complete payment
fhir:adjustment @<Money>?; # Payment adjustment for non-claim
# issues
fhir:adjustmentReason @<CodeableConcept>?; # Explanation for the adjustment
fhir:date @<Date>?; # Expected date of payment
fhir:amount @<Money>; # Payable amount after adjustment
fhir:identifier @<Identifier>?; # Business identifier for the payment
}
# Patient insurance information
<ClaimResponse.insurance> EXTENDS @<BackboneElement> CLOSED {
fhir:sequence @<PositiveInt>; # Insurance instance identifier
fhir:focal @<Boolean>; # Coverage to be used for
# adjudication
fhir:coverage @<Reference> AND {fhir:l
@<Coverage> ? }; # Insurance information
fhir:businessArrangement @<String>?; # Additional provider contract number
fhir:claimResponse @<Reference> AND {fhir:l
@<ClaimResponse> ? }?; # Adjudication results
}
# Adjudication totals
<ClaimResponse.total> EXTENDS @<BackboneElement> CLOSED {
fhir:category @<CodeableConcept>; # Type of adjudication information
fhir:amount @<Money>; # Financial total for the category
}
# Event information
<ClaimResponse.event> EXTENDS @<BackboneElement> CLOSED {
fhir:type @<CodeableConcept>; # Specific event
fhir:when @<DateTime> OR
@<Period> ; # Occurance date or period
}
# Adjudication details
<ClaimResponse.item.adjudication> EXTENDS @<BackboneElement> CLOSED {
fhir:category @<CodeableConcept>; # Type of adjudication information
fhir:reason @<CodeableConcept>?; # Explanation of adjudication outcome
fhir:amount @<Money>?; # Monetary amount
fhir:quantity @<Quantity>?; # Non-monetary value
fhir:decisionDate @<DateTime>?; # When was adjudication performed
}
# Adjudication for claim details
<ClaimResponse.item.detail> EXTENDS @<BackboneElement> CLOSED {
fhir:detailSequence @<PositiveInt>; # Claim detail instance identifier
fhir:traceNumber @<OneOrMore_Identifier>?; # Number for tracking
fhir:noteNumber @<OneOrMore_PositiveInt>?; # Applicable note numbers
fhir:reviewOutcome @<ClaimResponse.item.reviewOutcome>?; # Detail level adjudication results
fhir:adjudication @<OneOrMore_ClaimResponse.item.adjudication>?; # Detail level adjudication details
fhir:subDetail @<OneOrMore_ClaimResponse.item.detail.subDetail>?; # Adjudication for claim sub-details
}
# Processing errors
<ClaimResponse.error> EXTENDS @<BackboneElement> CLOSED {
fhir:itemSequence @<PositiveInt>?; # Item sequence number
fhir:detailSequence @<PositiveInt>?; # Detail sequence number
fhir:subDetailSequence @<PositiveInt>?; # Subdetail sequence number
fhir:code @<CodeableConcept>; # Error code detailing processing
# issues
fhir:expression @<OneOrMore_String>?; # FHIRPath of element(s) related to
# issue
}
# Adjudication for claim sub-details
<ClaimResponse.item.detail.subDetail> EXTENDS @<BackboneElement> CLOSED {
fhir:subDetailSequence @<PositiveInt>; # Claim sub-detail instance
# identifier
fhir:traceNumber @<OneOrMore_Identifier>?; # Number for tracking
fhir:noteNumber @<OneOrMore_PositiveInt>?; # Applicable note numbers
fhir:reviewOutcome @<ClaimResponse.item.reviewOutcome>?; # Subdetail level adjudication
# results
fhir:adjudication @<OneOrMore_ClaimResponse.item.adjudication>?; # Subdetail level adjudication
# details
}
# Adjudication results
<ClaimResponse.item.reviewOutcome> EXTENDS @<BackboneElement> CLOSED {
fhir:decision @<CodeableConcept>?; # Result of the adjudication
fhir:reason @<OneOrMore_CodeableConcept>?; # Reason for result of the
# adjudication
fhir:preAuthRef @<String>?; # Preauthorization reference
fhir:preAuthPeriod @<Period>?; # Preauthorization reference
# effective period
}
# Supporting information
<ClaimResponse.supportingInfo> EXTENDS @<BackboneElement> CLOSED {
fhir:sequence @<PositiveInt>; # Information instance identifier
fhir:category @<CodeableConcept>; # Classification of the supplied
# information
fhir:code @<CodeableConcept>?; # Type of information
fhir:timing @<DateTime> OR
@<Period> OR
@<Timing> ?; # When it occurred
fhir:value @<Base64Binary> OR
@<Boolean> OR
@<Canonical> OR
@<Code> OR
@<Date> OR
@<DateTime> OR
@<Decimal> OR
@<Id> OR
@<Instant> OR
@<Integer> OR
@<Integer64> OR
@<Markdown> OR
@<Oid> OR
@<PositiveInt> OR
@<String> OR
@<Time> OR
@<UnsignedInt> OR
@<Uri> OR
@<Url> OR
@<Uuid> OR
@<Address> OR
@<Age> OR
@<Annotation> OR
@<Attachment> OR
@<CodeableConcept> OR
@<CodeableReference> OR
@<Coding> OR
@<ContactPoint> OR
@<Count> OR
@<Distance> OR
@<Duration> OR
@<HumanName> OR
@<Identifier> OR
@<Money> OR
@<Period> OR
@<Quantity> OR
@<Range> OR
@<Ratio> OR
@<RatioRange> OR
@<Reference> OR
@<SampledData> OR
@<Signature> OR
@<Timing> OR
@<ContactDetail> OR
@<DataRequirement> OR
@<Expression> OR
@<ParameterDefinition> OR
@<RelatedArtifact> OR
@<TriggerDefinition> OR
@<UsageContext> OR
@<Availability> OR
@<ExtendedContactDetail> OR
@<VirtualServiceDetail> OR
@<Dosage> OR
@<Meta> ?; # Data to be provided
fhir:reason @<CodeableConcept>?; # Explanation for the information
}
# Insurer added line items
<ClaimResponse.addItem> EXTENDS @<BackboneElement> CLOSED {
fhir:itemSequence @<OneOrMore_PositiveInt>?; # Item sequence number
fhir:detailSequence @<OneOrMore_PositiveInt>?; # Detail sequence number
fhir:subdetailSequence @<OneOrMore_PositiveInt>?; # Subdetail sequence number
fhir:traceNumber @<OneOrMore_Identifier>?; # Number for tracking
fhir:subject @<Reference> AND {fhir:l
@<Group> OR
@<Patient> ? }?; # The recipient of the products and
# services
fhir:informationSequence @<OneOrMore_PositiveInt>?; # Applicable exception and
# supporting information
fhir:provider @<OneOrMore_Reference_Organization_OR_Practitioner_OR_PractitionerRole>?; # Authorized providers
fhir:revenue @<CodeableConcept>?; # Revenue or cost center code
fhir:category @<CodeableConcept>?; # Benefit classification
fhir:productOrService @<CodeableConcept>?; # Billing, service, product, or drug
# code
fhir:productOrServiceEnd @<CodeableConcept>?; # End of a range of codes
fhir:request @<OneOrMore_Reference_DeviceRequest_OR_MedicationRequest_OR_NutritionOrder_OR_ServiceRequest_OR_VisionPrescription>?; # Request or Referral for Service
fhir:modifier @<OneOrMore_CodeableConcept>?; # Service/Product billing modifiers
fhir:programCode @<OneOrMore_CodeableConcept>?; # Program the product or service is
# provided under
fhir:serviced @<Date> OR
@<Period> ?; # Date or dates of service or
# product delivery
fhir:location @<CodeableConcept> OR
@<Address> OR
(@<Reference> AND {fhir:l @<Location> }) ?; # Place of service or where product
# was supplied
fhir:quantity @<Quantity>?; # Count of products or services
fhir:unitPrice @<Money>?; # Fee, charge or cost per item
fhir:factor @<Decimal>?; # Price scaling factor
fhir:tax @<Money>?; # Total tax
fhir:net @<Money>?; # Total item cost
fhir:bodySite @<OneOrMore_ClaimResponse.addItem.bodySite>?; # Anatomical location
fhir:noteNumber @<OneOrMore_PositiveInt>?; # Applicable note numbers
fhir:reviewOutcome @<ClaimResponse.item.reviewOutcome>?; # Added items adjudication results
fhir:adjudication @<OneOrMore_ClaimResponse.item.adjudication>?; # Added items adjudication
fhir:detail @<OneOrMore_ClaimResponse.addItem.detail>?; # Insurer added line details
}
#---------------------- Cardinality Types (OneOrMore) -------------------
<OneOrMore_Identifier> CLOSED {
rdf:first @<Identifier> ;
rdf:rest [rdf:nil] OR @<OneOrMore_Identifier>
}
<OneOrMore_ClaimResponse.event> CLOSED {
rdf:first @<ClaimResponse.event> ;
rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.event>
}
<OneOrMore_Reference_Encounter> CLOSED {
rdf:first @<Reference> AND {fhir:l
@<Encounter> } ;
rdf:rest [rdf:nil] OR @<OneOrMore_Reference_Encounter>
}
<OneOrMore_ClaimResponse.supportingInfo> CLOSED {
rdf:first @<ClaimResponse.supportingInfo> ;
rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.supportingInfo>
}
<OneOrMore_ClaimResponse.item> CLOSED {
rdf:first @<ClaimResponse.item> ;
rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.item>
}
<OneOrMore_ClaimResponse.addItem> CLOSED {
rdf:first @<ClaimResponse.addItem> ;
rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.addItem>
}
<OneOrMore_ClaimResponse.item.adjudication> CLOSED {
rdf:first @<ClaimResponse.item.adjudication> ;
rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.item.adjudication>
}
<OneOrMore_ClaimResponse.total> CLOSED {
rdf:first @<ClaimResponse.total> ;
rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.total>
}
<OneOrMore_ClaimResponse.processNote> CLOSED {
rdf:first @<ClaimResponse.processNote> ;
rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.processNote>
}
<OneOrMore_Reference_CommunicationRequest> CLOSED {
rdf:first @<Reference> AND {fhir:l
@<CommunicationRequest> } ;
rdf:rest [rdf:nil] OR @<OneOrMore_Reference_CommunicationRequest>
}
<OneOrMore_ClaimResponse.insurance> CLOSED {
rdf:first @<ClaimResponse.insurance> ;
rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.insurance>
}
<OneOrMore_ClaimResponse.error> CLOSED {
rdf:first @<ClaimResponse.error> ;
rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.error>
}
<OneOrMore_PositiveInt> CLOSED {
rdf:first @<PositiveInt> ;
rdf:rest [rdf:nil] OR @<OneOrMore_PositiveInt>
}
<OneOrMore_ClaimResponse.item.detail> CLOSED {
rdf:first @<ClaimResponse.item.detail> ;
rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.item.detail>
}
<OneOrMore_CodeableConcept> CLOSED {
rdf:first @<CodeableConcept> ;
rdf:rest [rdf:nil] OR @<OneOrMore_CodeableConcept>
}
<OneOrMore_ClaimResponse.addItem.detail.subDetail> CLOSED {
rdf:first @<ClaimResponse.addItem.detail.subDetail> ;
rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.addItem.detail.subDetail>
}
<OneOrMore_CodeableReference> CLOSED {
rdf:first @<CodeableReference> ;
rdf:rest [rdf:nil] OR @<OneOrMore_CodeableReference>
}
<OneOrMore_ClaimResponse.item.detail.subDetail> CLOSED {
rdf:first @<ClaimResponse.item.detail.subDetail> ;
rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.item.detail.subDetail>
}
<OneOrMore_String> CLOSED {
rdf:first @<String> ;
rdf:rest [rdf:nil] OR @<OneOrMore_String>
}
<OneOrMore_Reference_Organization_OR_Practitioner_OR_PractitionerRole> CLOSED {
rdf:first @<Reference> AND {fhir:l
@<Organization> OR
@<Practitioner> OR
@<PractitionerRole> } ;
rdf:rest [rdf:nil] OR @<OneOrMore_Reference_Organization_OR_Practitioner_OR_PractitionerRole>
}
<OneOrMore_Reference_DeviceRequest_OR_MedicationRequest_OR_NutritionOrder_OR_ServiceRequest_OR_VisionPrescription> CLOSED {
rdf:first @<Reference> AND {fhir:l
@<DeviceRequest> OR
@<MedicationRequest> OR
@<NutritionOrder> OR
@<ServiceRequest> OR
@<VisionPrescription> } ;
rdf:rest [rdf:nil] OR @<OneOrMore_Reference_DeviceRequest_OR_MedicationRequest_OR_NutritionOrder_OR_ServiceRequest_OR_VisionPrescription>
}
<OneOrMore_ClaimResponse.addItem.bodySite> CLOSED {
rdf:first @<ClaimResponse.addItem.bodySite> ;
rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.addItem.bodySite>
}
<OneOrMore_ClaimResponse.addItem.detail> CLOSED {
rdf:first @<ClaimResponse.addItem.detail> ;
rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.addItem.detail>
}
#---------------------- Value Sets ------------------------
# This value set includes Claim Processing Outcome codes.
fhirvs:claim-outcome ["queued" "complete" "error" "partial"]
# The purpose of the Claim: predetermination, preauthorization, claim.
fhirvs:claim-use ["claim" "preauthorization" "predetermination"]
# This value set includes Status codes.
fhirvs:fm-status ["active" "cancelled" "draft" "entered-in-error"]
Usage
note:
every
effort
has
been
made
to
ensure
that
the
ShEx
files
are
correct
and
useful,
but
they
are
not
a
normative
part
of
the
specification.