7.1 13.1 Resource Claim - Content Resource Claim - Content

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

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <
 <</identifier>
 <</ruleset>
 <</originalRuleset>
 <
 <</target>
 <</provider>
 <</organization>
 <
 <</priority>
 <</fundsReserve>
 <</enterer>
 <</facility>
 <</prescription>
 <</originalPrescription>
 <
  <</type>
  <</provider>
  <</organization>
  <</person>

 <identifier><!-- 0..* Identifier Claim number --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <type><!-- 1..1 Coding Type or discipline --></type>
 <subType><!-- 0..* Coding Finer grained claim type information --></subType>
 <ruleset><!-- 0..1 Coding Current specification followed --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original specification followed --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <billablePeriod><!-- 0..1 Period Period for charge submission --></billablePeriod>
 <insurer[x]><!-- 0..1 Identifier|Reference(Organization) Target --></insurer[x]>
 <provider[x]><!-- 0..1 Identifier|Reference(Practitioner) Responsible provider --></provider[x]>
 <organization[x]><!-- 0..1 Identifier|Reference(Organization) Responsible organization --></organization[x]>
 <use value="[code]"/><!-- 0..1 complete | proposed | exploratory | other -->
 <priority><!-- 0..1 Coding Desired processing priority --></priority>
 <fundsReserve><!-- 0..1 Coding Funds requested to be reserved --></fundsReserve>
 <enterer[x]><!-- 0..1 Identifier|Reference(Practitioner) Author --></enterer[x]>
 <facility[x]><!-- 0..1 Identifier|Reference(Location) Servicing Facility --></facility[x]>
 <related>  <!-- 0..* Related Claims which may be revelant to processing this claimn -->
  <claim[x]><!-- 0..1 Identifier|Reference(Claim) Reference to the related claim --></claim[x]>
  <relationship><!-- 0..1 Coding How the reference claim is related --></relationship>
  <reference><!-- 0..1 Identifier Related file or case reference --></reference>
 </related>
 <prescription[x]><!-- 0..1 Identifier|Reference(MedicationOrder|
   VisionPrescription) Prescription --></prescription[x]>

 <originalPrescription[x]><!-- 0..1 Identifier|Reference(MedicationOrder) Original Prescription --></originalPrescription[x]>
 <payee>  <!-- 0..1 Party to be paid any benefits payable -->
  <type><!-- 1..1 Coding Type of party: Subscriber, Provider, other --></type>
  <resourceType><!-- 0..1 Coding organization | patient | practitioner | relatedperson --></resourceType>
  <party[x]><!-- 0..1 Identifier|Reference(Practitioner|Organization|Patient|
    RelatedPerson) Party to receive the payable --></party[x]>
 </payee>
 <</referral>
 <
  <
  <</diagnosis>

 <referral[x]><!-- 0..1 Identifier|Reference(ReferralRequest) Treatment Referral --></referral[x]>
 <information>  <!-- 0..* -->
  <category><!-- 1..1 Coding Category of information --></category>
  <code><!-- 0..1 Coding Type of information --></code>
  <timing[x]><!-- 0..1 date|Period When it occurred --></timing[x]>
  <value[x]><!-- 0..1 string|Quantity Additional Data --></value[x]>
 </information>
 <diagnosis>  <!-- 0..* Diagnosis -->
  <sequence value="[positiveInt]"/><!-- 1..1 Number to covey order of diagnosis -->
  <diagnosis><!-- 1..1 Coding Patient's diagnosis --></diagnosis>
  <type><!-- 0..* Coding Type of Diagnosis --></type>
  <drg><!-- 0..1 Coding Diagnosis Related Group --></drg>

 </diagnosis>
 <</condition>
 <</patient>
 <
  <
  <
  <</coverage>
  <
  <</relationship>
  <
  <</claimResponse>
  <</originalRuleset>

 <procedure>  <!-- 0..* Procedures performed -->
  <sequence value="[positiveInt]"/><!-- 1..1 Procedure sequence for reference -->
  <date value="[dateTime]"/><!-- 0..1 When the procedure was performed -->
  <procedure[x]><!-- 1..1 Coding|Reference(Procedure) Patient's list of procedures performed --></procedure[x]>
 </procedure>
 <patient[x]><!-- 1..1 Identifier|Reference(Patient) The subject of the Products and Services --></patient[x]>
 <coverage>  <!-- 0..* Insurance or medical plan -->
  <sequence value="[positiveInt]"/><!-- 1..1 Service instance identifier -->
  <focal value="[boolean]"/><!-- 1..1 Is the focal Coverage -->
  <coverage[x]><!-- 1..1 Identifier|Reference(Coverage) Insurance information --></coverage[x]>
  <businessArrangement value="[string]"/><!-- 0..1 Business agreement -->
  <preAuthRef value="[string]"/><!-- 0..* Pre-Authorization/Determination Reference -->
  <claimResponse><!-- 0..1 Reference(ClaimResponse) Adjudication results --></claimResponse>
  <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>

 </coverage>
 <</exception>
 <
 <
 <</accidentType>
 <</interventionException>
 <
  <
  <</type>
  <</provider>
  <
  <</service>
  <
  <</quantity>
  <</unitPrice>
  <
  <
  <</net>
  <</udi>
  <</bodySite>
  <</subSite>
  <</modifier>
  <
   <
   <</type>
   <</service>
   <</quantity>
   <</unitPrice>
   <
   <
   <</net>
   <</udi>
   <
    <
    <</type>
    <</service>
    <</quantity>
    <</unitPrice>
    <
    <
    <</net>
    <</udi>

 <accident> 
  <date value="[date]"/><!-- 1..1 When the accident occurred
see information codes
see information codes -->
  <type><!-- 0..1 Coding The nature of the accident --></type>
  <location[x]><!-- 0..1 Address|Reference(Location) Accident Place --></location[x]>
 </accident>
 <employmentImpacted><!-- 0..1 Period Period unable to work --></employmentImpacted>
 <hospitalization><!-- 0..1 Period Period in hospital --></hospitalization>
 <item>  <!-- 0..* Goods and Services -->
  <sequence value="[positiveInt]"/><!-- 1..1 Service instance -->
  <careTeam>  <!-- 0..* -->
   <provider[x]><!-- 1..1 Identifier|Reference(Practitioner|Organization) Provider individual or organization --></provider[x]>
   <responsible value="[boolean]"/><!-- 0..1 Billing provider -->
   <role><!-- 0..1 Coding Role on the team --></role>
   <qualification><!-- 0..1 Coding Type, classification or Specialization --></qualification>
  </careTeam>
  <diagnosisLinkId value="[positiveInt]"/><!-- 0..* Applicable diagnoses -->
  <revenue><!-- 0..1 Coding Revenue or cost center code --></revenue>
  <category><!-- 0..1 Coding Type of service or product --></category>
  <service><!-- 0..1 Coding Billing Code --></service>
  <modifier><!-- 0..* Coding Service/Product billing modifiers --></modifier>
  <programCode><!-- 0..* Coding Program specific reason for item inclusion --></programCode>
  <serviced[x]><!-- 0..1 date|Period Date or dates of Service --></serviced[x]>
  <location[x]><!-- 0..1 Coding|Address|Reference(Location) Place of service --></location[x]>
  <quantity><!-- 0..1 Quantity(SimpleQuantity) Count of Products or Services --></quantity>
  <unitPrice><!-- 0..1 Money Fee, charge or cost per point --></unitPrice>
  <factor value="[decimal]"/><!-- 0..1 Price scaling factor -->
  <points value="[decimal]"/><!-- 0..1 Difficulty scaling factor -->
  <net><!-- 0..1 Money Total item cost --></net>
  <udi><!-- 0..* Reference(Device) Unique Device Identifier --></udi>
  <bodySite><!-- 0..1 Coding Service Location --></bodySite>
  <subSite><!-- 0..* Coding Service Sub-location --></subSite>
  <detail>  <!-- 0..* Additional items -->
   <sequence value="[positiveInt]"/><!-- 1..1 Service instance -->
   <revenue><!-- 0..1 Coding Revenue or cost center code --></revenue>
   <category><!-- 0..1 Coding Type of service or product --></category>
   <service><!-- 0..1 Coding Billing Code --></service>
   <modifier><!-- 0..* Coding Service/Product billing modifiers --></modifier>
   <programCode><!-- 0..* Coding Program specific reason for item inclusion --></programCode>
   <quantity><!-- 0..1 Quantity(SimpleQuantity) Count of Products or Services --></quantity>
   <unitPrice><!-- 0..1 Money Fee, charge or cost per point --></unitPrice>
   <factor value="[decimal]"/><!-- 0..1 Price scaling factor -->
   <points value="[decimal]"/><!-- 0..1 Difficulty scaling factor -->
   <net><!-- 0..1 Money Total additional item cost --></net>
   <udi><!-- 0..* Reference(Device) Unique Device Identifier --></udi>
   <subDetail>  <!-- 0..* Additional items -->
    <sequence value="[positiveInt]"/><!-- 1..1 Service instance -->
    <revenue><!-- 0..1 Coding Revenue or cost center code --></revenue>
    <category><!-- 0..1 Coding Type of service or product --></category>
    <service><!-- 0..1 Coding Billing Code --></service>
    <modifier><!-- 0..* Coding Service/Product billing modifiers --></modifier>
    <programCode><!-- 0..* Coding Program specific reason for item inclusion --></programCode>
    <quantity><!-- 0..1 Quantity(SimpleQuantity) Count of Products or Services --></quantity>
    <unitPrice><!-- 0..1 Money Fee, charge or cost per point --></unitPrice>
    <factor value="[decimal]"/><!-- 0..1 Price scaling factor -->
    <points value="[decimal]"/><!-- 0..1 Difficulty scaling factor -->
    <net><!-- 0..1 Money Net additional item cost --></net>
    <udi><!-- 0..* Reference(Device) Unique Device Identifier --></udi>

   </subDetail>
  </detail>
  <
   <
   <
   <</priorMaterial>

  <prosthesis>  <!-- 0..1 Prosthetic details -->
   <initial value="[boolean]"/><!-- 0..1 Is this the initial service -->
   <priorDate value="[date]"/><!-- 0..1 Initial service Date -->
   <priorMaterial><!-- 0..1 Coding Prosthetic Material --></priorMaterial>

  </prosthesis>
 </item>
 <</additionalMaterials>
 <
  <</tooth>
  <</reason>
  <

 <total><!-- 0..1 Money Total claim cost --></total>
 <missingTeeth>  <!-- 0..* Only if type = oral -->
  <tooth><!-- 1..1 Coding Tooth Code --></tooth>
  <reason><!-- 0..1 Coding Indicates whether it was extracted or other reason --></reason>
  <extractionDate value="[date]"/><!-- 0..1 Date tooth was extracted if known -->

 </missingTeeth>
</Claim>

{
  "resourceType" : "Claim",

  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
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  "identifier" : [{ Identifier }], // Claim number
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  "type" : { Coding }, // R!  Type or discipline
  "subType" : [{ Coding }], // Finer grained claim type information
  "ruleset" : { Coding }, // Current specification followed
  "originalRuleset" : { Coding }, // Original specification followed
  "created" : "<dateTime>", // Creation date
  "billablePeriod" : { Period }, // Period for charge submission
  // insurer[x]: Target. One of these 2:

  "insurerIdentifier" : { Identifier },
  "insurerReference" : { Reference(Organization) },
  // provider[x]: Responsible provider. One of these 2:

  "providerIdentifier" : { Identifier },
  "providerReference" : { Reference(Practitioner) },
  // organization[x]: Responsible organization. One of these 2:

  "organizationIdentifier" : { Identifier },
  "organizationReference" : { Reference(Organization) },
  "use" : "<code>", // complete | proposed | exploratory | other
  "priority" : { Coding }, // Desired processing priority
  "fundsReserve" : { Coding }, // Funds requested to be reserved
  // enterer[x]: Author. One of these 2:

  "entererIdentifier" : { Identifier },
  "entererReference" : { Reference(Practitioner) },
  // facility[x]: Servicing Facility. One of these 2:

  "facilityIdentifier" : { Identifier },
  "facilityReference" : { Reference(Location) },
  "related" : [{ // Related Claims which may be revelant to processing this claimn
    // claim[x]: Reference to the related claim. One of these 2:

    "claimIdentifier" : { Identifier },
    "claimReference" : { Reference(Claim) },
    "relationship" : { Coding }, // How the reference claim is related
    "reference" : { Identifier } // Related file or case reference
  }],
  // prescription[x]: Prescription. One of these 2:

  "prescriptionIdentifier" : { Identifier },
  "prescriptionReference" : { Reference(MedicationOrder|VisionPrescription) },
  // originalPrescription[x]: Original Prescription. One of these 2:

  "originalPrescriptionIdentifier" : { Identifier },
  "originalPrescriptionReference" : { Reference(MedicationOrder) },
  "payee" : { // Party to be paid any benefits payable
    "type" : { Coding }, // R!  Type of party: Subscriber, Provider, other
    "resourceType" : { Coding }, // organization | patient | practitioner | relatedperson
    // party[x]: Party to receive the payable. One of these 2:

    "partyIdentifier" : { Identifier }
    "partyReference" : { Reference(Practitioner|Organization|Patient|RelatedPerson) }

  },
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  // referral[x]: Treatment Referral. One of these 2:
  "referralIdentifier" : { Identifier },
  "referralReference" : { Reference(ReferralRequest) },
  "information" : [{ // 
    "category" : { Coding }, // R!  Category of information
    "code" : { Coding }, // Type of information
    // timing[x]: When it occurred. One of these 2:

    "timingDate" : "<date>",
    "timingPeriod" : { Period },
    // value[x]: Additional Data. One of these 2:

    "valueString" : "<string>"
    "valueQuantity" : { Quantity }

  }],
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  "diagnosis" : [{ // Diagnosis
    "sequence" : "<positiveInt>", // R!  Number to covey order of diagnosis
    "diagnosis" : { Coding }, // R!  Patient's diagnosis
    "type" : [{ Coding }], // Type of Diagnosis
    "drg" : { Coding } // Diagnosis Related Group

  }],
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  "procedure" : [{ // Procedures performed
    "sequence" : "<positiveInt>", // R!  Procedure sequence for reference
    "date" : "<dateTime>", // When the procedure was performed
    // procedure[x]: Patient's list of procedures performed. One of these 2:

    "procedureCoding" : { Coding }
    "procedureReference" : { Reference(Procedure) }
  }],
  // patient[x]: The subject of the Products and Services. One of these 2:

  "patientIdentifier" : { Identifier },
  "patientReference" : { Reference(Patient) },
  "coverage" : [{ // Insurance or medical plan
    "sequence" : "<positiveInt>", // R!  Service instance identifier
    "focal" : <boolean>, // R!  Is the focal Coverage
    // coverage[x]: Insurance information. One of these 2:

    "coverageIdentifier" : { Identifier },
    "coverageReference" : { Reference(Coverage) },
    "businessArrangement" : "<string>", // Business agreement
    "preAuthRef" : ["<string>"], // Pre-Authorization/Determination Reference
    "claimResponse" : { Reference(ClaimResponse) }, // Adjudication results
    "originalRuleset" : { Coding } // Original version
  }],
  "accident" : { // 
    "date" : "<date>", // R!  When the accident occurred
see information codes
see information codes
    "type" : { Coding }, // The nature of the accident
    // location[x]: Accident Place. One of these 2:

    "locationAddress" : { Address }
    "locationReference" : { Reference(Location) }
  },
  "employmentImpacted" : { Period }, // Period unable to work
  "hospitalization" : { Period }, // Period in hospital
  "item" : [{ // Goods and Services
    "sequence" : "<positiveInt>", // R!  Service instance
    "careTeam" : [{ // 
      // provider[x]: Provider individual or organization. One of these 2:

      "providerIdentifier" : { Identifier },
      "providerReference" : { Reference(Practitioner|Organization) },
      "responsible" : <boolean>, // Billing provider
      "role" : { Coding }, // Role on the team
      "qualification" : { Coding } // Type, classification or Specialization
    }],
    "diagnosisLinkId" : ["<positiveInt>"], // Applicable diagnoses
    "revenue" : { Coding }, // Revenue or cost center code
    "category" : { Coding }, // Type of service or product
    "service" : { Coding }, // Billing Code
    "modifier" : [{ Coding }], // Service/Product billing modifiers
    "programCode" : [{ Coding }], // Program specific reason for item inclusion
    // serviced[x]: Date or dates of Service. One of these 2:

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

    "locationCoding" : { Coding },
    "locationAddress" : { Address },
    "locationReference" : { Reference(Location) },
    "quantity" : { Quantity(SimpleQuantity) }, // Count of Products or Services
    "unitPrice" : { Money }, // Fee, charge or cost per point
    "factor" : <decimal>, // Price scaling factor
    "points" : <decimal>, // Difficulty scaling factor
    "net" : { Money }, // Total item cost
    "udi" : [{ Reference(Device) }], // Unique Device Identifier
    "bodySite" : { Coding }, // Service Location
    "subSite" : [{ Coding }], // Service Sub-location
    "detail" : [{ // Additional items
      "sequence" : "<positiveInt>", // R!  Service instance
      "revenue" : { Coding }, // Revenue or cost center code
      "category" : { Coding }, // Type of service or product
      "service" : { Coding }, // Billing Code
      "modifier" : [{ Coding }], // Service/Product billing modifiers
      "programCode" : [{ Coding }], // Program specific reason for item inclusion
      "quantity" : { Quantity(SimpleQuantity) }, // Count of Products or Services
      "unitPrice" : { Money }, // Fee, charge or cost per point
      "factor" : <decimal>, // Price scaling factor
      "points" : <decimal>, // Difficulty scaling factor
      "net" : { Money }, // Total additional item cost
      "udi" : [{ Reference(Device) }], // Unique Device Identifier
      "subDetail" : [{ // Additional items
        "sequence" : "<positiveInt>", // R!  Service instance
        "revenue" : { Coding }, // Revenue or cost center code
        "category" : { Coding }, // Type of service or product
        "service" : { Coding }, // Billing Code
        "modifier" : [{ Coding }], // Service/Product billing modifiers
        "programCode" : [{ Coding }], // Program specific reason for item inclusion
        "quantity" : { Quantity(SimpleQuantity) }, // Count of Products or Services
        "unitPrice" : { Money }, // Fee, charge or cost per point
        "factor" : <decimal>, // Price scaling factor
        "points" : <decimal>, // Difficulty scaling factor
        "net" : { Money }, // Net additional item cost
        "udi" : [{ Reference(Device) }] // Unique Device Identifier

      }]
    }],
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    "prosthesis" : { // Prosthetic details
      "initial" : <boolean>, // Is this the initial service
      "priorDate" : "<date>", // Initial service Date
      "priorMaterial" : { Coding } // Prosthetic Material

    }
  }],
  "
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  "total" : { Money }, // Total claim cost
  "missingTeeth" : [{ // Only if type = oral
    "tooth" : { Coding }, // R!  Tooth Code
    "reason" : { Coding }, // Indicates whether it was extracted or other reason
    "extractionDate" : "<date>" // Date tooth was extracted if known

  }]
}

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


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

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Claim.identifier [ Identifier ], ... ; # 0..* Claim number
  fhir:Claim.status [ code ]; # 1..1 active | cancelled | draft | entered-in-error
  fhir:Claim.type [ Coding ]; # 1..1 Type or discipline
  fhir:Claim.subType [ Coding ], ... ; # 0..* Finer grained claim type information
  fhir:Claim.ruleset [ Coding ]; # 0..1 Current specification followed
  fhir:Claim.originalRuleset [ Coding ]; # 0..1 Original specification followed
  fhir:Claim.created [ dateTime ]; # 0..1 Creation date
  fhir:Claim.billablePeriod [ Period ]; # 0..1 Period for charge submission
  # Claim.insurer[x] : 0..1 Target. One of these 2
    fhir:Claim.insurerIdentifier [ Identifier ]
    fhir:Claim.insurerReference [ Reference(Organization) ]
  # Claim.provider[x] : 0..1 Responsible provider. One of these 2
    fhir:Claim.providerIdentifier [ Identifier ]
    fhir:Claim.providerReference [ Reference(Practitioner) ]
  # Claim.organization[x] : 0..1 Responsible organization. One of these 2
    fhir:Claim.organizationIdentifier [ Identifier ]
    fhir:Claim.organizationReference [ Reference(Organization) ]
  fhir:Claim.use [ code ]; # 0..1 complete | proposed | exploratory | other
  fhir:Claim.priority [ Coding ]; # 0..1 Desired processing priority
  fhir:Claim.fundsReserve [ Coding ]; # 0..1 Funds requested to be reserved
  # Claim.enterer[x] : 0..1 Author. One of these 2
    fhir:Claim.entererIdentifier [ Identifier ]
    fhir:Claim.entererReference [ Reference(Practitioner) ]
  # Claim.facility[x] : 0..1 Servicing Facility. One of these 2
    fhir:Claim.facilityIdentifier [ Identifier ]
    fhir:Claim.facilityReference [ Reference(Location) ]
  fhir:Claim.related [ # 0..* Related Claims which may be revelant to processing this claimn
    # Claim.related.claim[x] : 0..1 Reference to the related claim. One of these 2
      fhir:Claim.related.claimIdentifier [ Identifier ]
      fhir:Claim.related.claimReference [ Reference(Claim) ]
    fhir:Claim.related.relationship [ Coding ]; # 0..1 How the reference claim is related
    fhir:Claim.related.reference [ Identifier ]; # 0..1 Related file or case reference
  ], ...;
  # Claim.prescription[x] : 0..1 Prescription. One of these 2
    fhir:Claim.prescriptionIdentifier [ Identifier ]
    fhir:Claim.prescriptionReference [ Reference(MedicationOrder|VisionPrescription) ]
  # Claim.originalPrescription[x] : 0..1 Original Prescription. One of these 2
    fhir:Claim.originalPrescriptionIdentifier [ Identifier ]
    fhir:Claim.originalPrescriptionReference [ Reference(MedicationOrder) ]
  fhir:Claim.payee [ # 0..1 Party to be paid any benefits payable
    fhir:Claim.payee.type [ Coding ]; # 1..1 Type of party: Subscriber, Provider, other
    fhir:Claim.payee.resourceType [ Coding ]; # 0..1 organization | patient | practitioner | relatedperson
    # Claim.payee.party[x] : 0..1 Party to receive the payable. One of these 2
      fhir:Claim.payee.partyIdentifier [ Identifier ]
      fhir:Claim.payee.partyReference [ Reference(Practitioner|Organization|Patient|RelatedPerson) ]
  ];
  # Claim.referral[x] : 0..1 Treatment Referral. One of these 2
    fhir:Claim.referralIdentifier [ Identifier ]
    fhir:Claim.referralReference [ Reference(ReferralRequest) ]
  fhir:Claim.information [ # 0..* 
    fhir:Claim.information.category [ Coding ]; # 1..1 Category of information
    fhir:Claim.information.code [ Coding ]; # 0..1 Type of information
    # Claim.information.timing[x] : 0..1 When it occurred. One of these 2
      fhir:Claim.information.timingDate [ date ]
      fhir:Claim.information.timingPeriod [ Period ]
    # Claim.information.value[x] : 0..1 Additional Data. One of these 2
      fhir:Claim.information.valueString [ string ]
      fhir:Claim.information.valueQuantity [ Quantity ]
  ], ...;
  fhir:Claim.diagnosis [ # 0..* Diagnosis
    fhir:Claim.diagnosis.sequence [ positiveInt ]; # 1..1 Number to covey order of diagnosis
    fhir:Claim.diagnosis.diagnosis [ Coding ]; # 1..1 Patient's diagnosis
    fhir:Claim.diagnosis.type [ Coding ], ... ; # 0..* Type of Diagnosis
    fhir:Claim.diagnosis.drg [ Coding ]; # 0..1 Diagnosis Related Group
  ], ...;
  fhir:Claim.procedure [ # 0..* Procedures performed
    fhir:Claim.procedure.sequence [ positiveInt ]; # 1..1 Procedure sequence for reference
    fhir:Claim.procedure.date [ dateTime ]; # 0..1 When the procedure was performed
    # Claim.procedure.procedure[x] : 1..1 Patient's list of procedures performed. One of these 2
      fhir:Claim.procedure.procedureCoding [ Coding ]
      fhir:Claim.procedure.procedureReference [ Reference(Procedure) ]
  ], ...;
  # Claim.patient[x] : 1..1 The subject of the Products and Services. One of these 2
    fhir:Claim.patientIdentifier [ Identifier ]
    fhir:Claim.patientReference [ Reference(Patient) ]
  fhir:Claim.coverage [ # 0..* Insurance or medical plan
    fhir:Claim.coverage.sequence [ positiveInt ]; # 1..1 Service instance identifier
    fhir:Claim.coverage.focal [ boolean ]; # 1..1 Is the focal Coverage
    # Claim.coverage.coverage[x] : 1..1 Insurance information. One of these 2
      fhir:Claim.coverage.coverageIdentifier [ Identifier ]
      fhir:Claim.coverage.coverageReference [ Reference(Coverage) ]
    fhir:Claim.coverage.businessArrangement [ string ]; # 0..1 Business agreement
    fhir:Claim.coverage.preAuthRef [ string ], ... ; # 0..* Pre-Authorization/Determination Reference
    fhir:Claim.coverage.claimResponse [ Reference(ClaimResponse) ]; # 0..1 Adjudication results
    fhir:Claim.coverage.originalRuleset [ Coding ]; # 0..1 Original version
  ], ...;
  fhir:Claim.accident [ # 0..1 
    fhir:Claim.accident.date [ date ]; # 1..1 When the accident occurred
see information codes
see information codes
    fhir:Claim.accident.type [ Coding ]; # 0..1 The nature of the accident
    # Claim.accident.location[x] : 0..1 Accident Place. One of these 2
      fhir:Claim.accident.locationAddress [ Address ]
      fhir:Claim.accident.locationReference [ Reference(Location) ]
  ];
  fhir:Claim.employmentImpacted [ Period ]; # 0..1 Period unable to work
  fhir:Claim.hospitalization [ Period ]; # 0..1 Period in hospital
  fhir:Claim.item [ # 0..* Goods and Services
    fhir:Claim.item.sequence [ positiveInt ]; # 1..1 Service instance
    fhir:Claim.item.careTeam [ # 0..* 
      # Claim.item.careTeam.provider[x] : 1..1 Provider individual or organization. One of these 2
        fhir:Claim.item.careTeam.providerIdentifier [ Identifier ]
        fhir:Claim.item.careTeam.providerReference [ Reference(Practitioner|Organization) ]
      fhir:Claim.item.careTeam.responsible [ boolean ]; # 0..1 Billing provider
      fhir:Claim.item.careTeam.role [ Coding ]; # 0..1 Role on the team
      fhir:Claim.item.careTeam.qualification [ Coding ]; # 0..1 Type, classification or Specialization
    ], ...;
    fhir:Claim.item.diagnosisLinkId [ positiveInt ], ... ; # 0..* Applicable diagnoses
    fhir:Claim.item.revenue [ Coding ]; # 0..1 Revenue or cost center code
    fhir:Claim.item.category [ Coding ]; # 0..1 Type of service or product
    fhir:Claim.item.service [ Coding ]; # 0..1 Billing Code
    fhir:Claim.item.modifier [ Coding ], ... ; # 0..* Service/Product billing modifiers
    fhir:Claim.item.programCode [ Coding ], ... ; # 0..* Program specific reason for item inclusion
    # Claim.item.serviced[x] : 0..1 Date or dates of Service. One of these 2
      fhir:Claim.item.servicedDate [ date ]
      fhir:Claim.item.servicedPeriod [ Period ]
    # Claim.item.location[x] : 0..1 Place of service. One of these 3
      fhir:Claim.item.locationCoding [ Coding ]
      fhir:Claim.item.locationAddress [ Address ]
      fhir:Claim.item.locationReference [ Reference(Location) ]
    fhir:Claim.item.quantity [ Quantity(SimpleQuantity) ]; # 0..1 Count of Products or Services
    fhir:Claim.item.unitPrice [ Money ]; # 0..1 Fee, charge or cost per point
    fhir:Claim.item.factor [ decimal ]; # 0..1 Price scaling factor
    fhir:Claim.item.points [ decimal ]; # 0..1 Difficulty scaling factor
    fhir:Claim.item.net [ Money ]; # 0..1 Total item cost
    fhir:Claim.item.udi [ Reference(Device) ], ... ; # 0..* Unique Device Identifier
    fhir:Claim.item.bodySite [ Coding ]; # 0..1 Service Location
    fhir:Claim.item.subSite [ Coding ], ... ; # 0..* Service Sub-location
    fhir:Claim.item.detail [ # 0..* Additional items
      fhir:Claim.item.detail.sequence [ positiveInt ]; # 1..1 Service instance
      fhir:Claim.item.detail.revenue [ Coding ]; # 0..1 Revenue or cost center code
      fhir:Claim.item.detail.category [ Coding ]; # 0..1 Type of service or product
      fhir:Claim.item.detail.service [ Coding ]; # 0..1 Billing Code
      fhir:Claim.item.detail.modifier [ Coding ], ... ; # 0..* Service/Product billing modifiers
      fhir:Claim.item.detail.programCode [ Coding ], ... ; # 0..* Program specific reason for item inclusion
      fhir:Claim.item.detail.quantity [ Quantity(SimpleQuantity) ]; # 0..1 Count of Products or Services
      fhir:Claim.item.detail.unitPrice [ Money ]; # 0..1 Fee, charge or cost per point
      fhir:Claim.item.detail.factor [ decimal ]; # 0..1 Price scaling factor
      fhir:Claim.item.detail.points [ decimal ]; # 0..1 Difficulty scaling factor
      fhir:Claim.item.detail.net [ Money ]; # 0..1 Total additional item cost
      fhir:Claim.item.detail.udi [ Reference(Device) ], ... ; # 0..* Unique Device Identifier
      fhir:Claim.item.detail.subDetail [ # 0..* Additional items
        fhir:Claim.item.detail.subDetail.sequence [ positiveInt ]; # 1..1 Service instance
        fhir:Claim.item.detail.subDetail.revenue [ Coding ]; # 0..1 Revenue or cost center code
        fhir:Claim.item.detail.subDetail.category [ Coding ]; # 0..1 Type of service or product
        fhir:Claim.item.detail.subDetail.service [ Coding ]; # 0..1 Billing Code
        fhir:Claim.item.detail.subDetail.modifier [ Coding ], ... ; # 0..* Service/Product billing modifiers
        fhir:Claim.item.detail.subDetail.programCode [ Coding ], ... ; # 0..* Program specific reason for item inclusion
        fhir:Claim.item.detail.subDetail.quantity [ Quantity(SimpleQuantity) ]; # 0..1 Count of Products or Services
        fhir:Claim.item.detail.subDetail.unitPrice [ Money ]; # 0..1 Fee, charge or cost per point
        fhir:Claim.item.detail.subDetail.factor [ decimal ]; # 0..1 Price scaling factor
        fhir:Claim.item.detail.subDetail.points [ decimal ]; # 0..1 Difficulty scaling factor
        fhir:Claim.item.detail.subDetail.net [ Money ]; # 0..1 Net additional item cost
        fhir:Claim.item.detail.subDetail.udi [ Reference(Device) ], ... ; # 0..* Unique Device Identifier
      ], ...;
    ], ...;
    fhir:Claim.item.prosthesis [ # 0..1 Prosthetic details
      fhir:Claim.item.prosthesis.initial [ boolean ]; # 0..1 Is this the initial service
      fhir:Claim.item.prosthesis.priorDate [ date ]; # 0..1 Initial service Date
      fhir:Claim.item.prosthesis.priorMaterial [ Coding ]; # 0..1 Prosthetic Material
    ];
  ], ...;
  fhir:Claim.total [ Money ]; # 0..1 Total claim cost
  fhir:Claim.missingTeeth [ # 0..* Only if type = oral
    fhir:Claim.missingTeeth.tooth [ Coding ]; # 1..1 Tooth Code
    fhir:Claim.missingTeeth.reason [ Coding ]; # 0..1 Indicates whether it was extracted or other reason
    fhir:Claim.missingTeeth.extractionDate [ date ]; # 0..1 Date tooth was extracted if known
  ], ...;
]

See the Full Difference for further information