13.6 Resource Claim - Content

<Claim xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Claim number --></identifier>
 <status value="[code]"/><!-- 0..1 active | cancelled | draft | entered-in-error -->
 <</type>
 <</subType>
 <

 <type><!-- 0..1 CodeableConcept Type or discipline --></type>
 <subType><!-- 0..1 CodeableConcept Finer grained claim type information --></subType>
 <use value="[code]"/><!-- 0..1 claim | preauthorization | predetermination -->

 <patient><!-- 0..1 Reference(Patient) The subject of the Products and Services --></patient>
 <billablePeriod><!-- 0..1 Period Period for charge submission --></billablePeriod>
 <

 <created value="[dateTime]"/><!-- 0..1 Creation date -->

 <enterer><!-- 0..1 Reference(Practitioner|PractitionerRole) Author --></enterer>
 <insurer><!-- 0..1 Reference(Organization) Target --></insurer>
 <provider><!-- 0..1 Reference(Practitioner|PractitionerRole|Organization) Responsible provider --></provider>
 <priority><!-- 0..1 CodeableConcept Desired processing priority --></priority>
 <fundsReserve><!-- 0..1 CodeableConcept Funds requested to be reserved --></fundsReserve>
 <

 <related>  <!-- 0..* Related Claims which may be relevant to processing this claim -->

  <claim><!-- 0..1 Reference(Claim) Reference to the related claim --></claim>
  <</relationship>
  <</reference>

  <relationship><!-- 0..1 CodeableConcept How the reference claim is related --></relationship>
  <reference><!-- 0..1 Identifier Related file or case reference --></reference>

 </related>
 <prescription><!-- 0..1 Reference(MedicationRequest|VisionPrescription) Prescription authorizing services or products --></prescription>
 <</originalPrescription>

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!-- 0..1 Reference(MedicationRequest) Original prescription if superseded by fulfiller --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

 <payee>  <!-- 0..1 Party to be paid any benefits payable -->
  <type><!-- 1..1 CodeableConcept Type of party: Subscriber, Provider, other --></type>
  <resource><!-- 0..1 Coding organization | patient | practitioner | relatedperson --></resource>
  <party><!-- 0..1 Reference(Practitioner|PractitionerRole|Organization|Patient|
    RelatedPerson) Party to receive the payable --></party>
 </payee>
 <referral><!-- 0..1 Reference(ServiceRequest) Treatment Referral --></referral>
 <facility><!-- 0..1 Reference(Location) Servicing Facility --></facility>
 <careTeam>  <!-- 0..* Members of the care team -->
  <sequence value="[positiveInt]"/><!-- 1..1 Number to convey order of careTeam -->
  <provider><!-- 1..1 Reference(Practitioner|PractitionerRole|Organization) Provider individual or organization --></provider>
  <responsible value="[boolean]"/><!-- 0..1 Billing provider -->
  <</role>

  <role><!-- 0..1 CodeableConcept Role on the team --></role>

  <qualification><!-- 0..1 CodeableConcept Type, classification or Specialization --></qualification>
 </careTeam>
 <

 <information>  <!-- 0..* Exceptions, special considerations, the condition, situation, prior or concurrent issues -->

  <sequence value="[positiveInt]"/><!-- 1..1 Information instance identifier -->
  <category><!-- 1..1 CodeableConcept General class of information --></category>
  <code><!-- 0..1 CodeableConcept Type of information --></code>
  <timing[x]><!-- 0..1 date|Period When it occurred --></timing[x]>
  <value[x]><!-- 0..1 boolean|string|Quantity|Attachment|Reference(Any) Additional Data or supporting information --></value[x]>
  <reason><!-- 0..1 CodeableConcept Reason associated with the information --></reason>
 </information>
 <diagnosis>  <!-- 0..* List of Diagnosis -->
  <sequence value="[positiveInt]"/><!-- 1..1 Number to convey order of diagnosis -->
  <diagnosis[x]><!-- 1..1 CodeableConcept|Reference(Condition) Patient's diagnosis --></diagnosis[x]>
  <type><!-- 0..* CodeableConcept Timing or nature of the diagnosis --></type>
  <onAdmission><!-- 0..1 CodeableConcept Present on admission --></onAdmission>

  <packageCode><!-- 0..1 CodeableConcept Package billing code --></packageCode>
 </diagnosis>
 <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 CodeableConcept|Reference(Procedure) Patient's list of procedures performed --></procedure[x]>
 </procedure>
 <insurance>  <!-- 0..* Insurance or medical plan -->
  <sequence value="[positiveInt]"/><!-- 1..1 Service instance identifier -->
  <focal value="[boolean]"/><!-- 1..1 Is the focal Coverage -->
  <identifier><!-- 0..1 Identifier Claim number --></identifier>
  <coverage><!-- 1..1 Reference(Coverage) Insurance information --></coverage>
  <businessArrangement value="[string]"/><!-- 0..1 Business agreement -->
  <preAuthRef value="[string]"/><!-- 0..* Pre-Authorization/Determination Reference -->
  <claimResponse><!-- 0..1 Reference(ClaimResponse) Adjudication results --></claimResponse>
 </insurance>
 <accident>  <!-- 0..1 Details about an accident -->
  <date value="[date]"/><!-- 1..1 When the accident occurred
see information codes
see information codes -->
  <type><!-- 0..1 CodeableConcept The nature of the accident --></type>
  <location[x]><!-- 0..1 Address|Reference(Location) Accident Place --></location[x]>
 </accident>
 <item>  <!-- 0..* Goods and Services -->
  <sequence value="[positiveInt]"/><!-- 1..1 Service instance -->
  <careTeamSequence value="[positiveInt]"/><!-- 0..* Applicable careTeam members -->
  <diagnosisSequence value="[positiveInt]"/><!-- 0..* Applicable diagnoses -->
  <procedureSequence value="[positiveInt]"/><!-- 0..* Applicable procedures -->
  <
  <</revenue>
  <</category>
  <</service>
  <</modifier>

  <informationSequence value="[positiveInt]"/><!-- 0..* Applicable exception and supporting information -->
  <revenue><!-- 0..1 CodeableConcept Revenue or cost center code --></revenue>
  <category><!-- 0..1 CodeableConcept Type of service or product --></category>
  <billcode><!-- 0..1 CodeableConcept Billing Code --></billcode>
  <modifier><!-- 0..* CodeableConcept Service/Product billing modifiers --></modifier>

  <programCode><!-- 0..* CodeableConcept Program specific reason for item inclusion --></programCode>
  <</serviced[x]>

  <serviced[x]><!-- 0..1 date|Period Date or dates of Service --></serviced[x]>

  <location[x]><!-- 0..1 CodeableConcept|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 -->
  <</net>

  <net><!-- 0..1 Money Total item cost --></net>

  <udi><!-- 0..* Reference(Device) Unique Device Identifier --></udi>
  <bodySite><!-- 0..1 CodeableConcept Service Location --></bodySite>
  <</subSite>

  <subSite><!-- 0..* CodeableConcept Service Sub-location --></subSite>

  <encounter><!-- 0..* Reference(Encounter) Encounters related to this billed item --></encounter>
  <detail>  <!-- 0..* Additional items -->
   <sequence value="[positiveInt]"/><!-- 1..1 Service instance -->
   <</revenue>
   <</category>
   <</service>
   <</modifier>

   <revenue><!-- 0..1 CodeableConcept Revenue or cost center code --></revenue>
   <category><!-- 0..1 CodeableConcept Type of service or product --></category>
   <billcode><!-- 0..1 CodeableConcept Billing Code --></billcode>
   <modifier><!-- 0..* CodeableConcept Service/Product billing modifiers --></modifier>

   <programCode><!-- 0..* CodeableConcept 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 -->
   <</net>

   <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>
    <</category>
    <</service>
    <</modifier>

    <revenue><!-- 0..1 CodeableConcept Revenue or cost center code --></revenue>
    <category><!-- 0..1 CodeableConcept Type of service or product --></category>
    <billcode><!-- 0..1 CodeableConcept Billing Code --></billcode>
    <modifier><!-- 0..* CodeableConcept Service/Product billing modifiers --></modifier>

    <programCode><!-- 0..* CodeableConcept 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 -->
    <</net>

    <net><!-- 0..1 Money Net additional item cost --></net>

    <udi><!-- 0..* Reference(Device) Unique Device Identifier --></udi>
   </subDetail>
  </detail>
 </item>
 <total><!-- 0..1 Money Total claim cost --></total>
</Claim>

{
  "resourceType" : "Claim",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Claim number
  "status" : "<code>", // active | cancelled | draft | entered-in-error
  "
  "
  "

  "type" : { CodeableConcept }, // Type or discipline
  "subType" : { CodeableConcept }, // Finer grained claim type information
  "use" : "<code>", // claim | preauthorization | predetermination

  "patient" : { Reference(Patient) }, // The subject of the Products and Services
  "billablePeriod" : { Period }, // Period for charge submission
  "

  "created" : "<dateTime>", // Creation date

  "enterer" : { Reference(Practitioner|PractitionerRole) }, // Author
  "insurer" : { Reference(Organization) }, // Target
  "provider" : { Reference(Practitioner|PractitionerRole|Organization) }, // Responsible provider
  "priority" : { CodeableConcept }, // Desired processing priority
  "fundsReserve" : { CodeableConcept }, // Funds requested to be reserved
  "

  "related" : [{ // Related Claims which may be relevant to processing this claim

    "claim" : { Reference(Claim) }, // Reference to the related claim
    "
    "

    "relationship" : { CodeableConcept }, // How the reference claim is related
    "reference" : { Identifier } // Related file or case reference

  }],
  "prescription" : { Reference(MedicationRequest|VisionPrescription) }, // Prescription authorizing services or products
  "

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

  "payee" : { // Party to be paid any benefits payable
    "type" : { CodeableConcept }, // R!  Type of party: Subscriber, Provider, other
    "resource" : { Coding }, // organization | patient | practitioner | relatedperson
    "party" : { Reference(Practitioner|PractitionerRole|Organization|Patient|
    RelatedPerson) } // Party to receive the payable
  },
  "referral" : { Reference(ServiceRequest) }, // Treatment Referral
  "facility" : { Reference(Location) }, // Servicing Facility
  "careTeam" : [{ // Members of the care team
    "sequence" : "<positiveInt>", // R!  Number to convey order of careTeam
    "provider" : { Reference(Practitioner|PractitionerRole|Organization) }, // R!  Provider individual or organization
    "responsible" : <boolean>, // Billing provider
    "

    "role" : { CodeableConcept }, // Role on the team

    "qualification" : { CodeableConcept } // Type, classification or Specialization
  }],
  "

  "information" : [{ // Exceptions, special considerations, the condition, situation, prior or concurrent issues

    "sequence" : "<positiveInt>", // R!  Information instance identifier
    "category" : { CodeableConcept }, // R!  General class of information
    "code" : { CodeableConcept }, // Type of information
    // timing[x]: When it occurred. One of these 2:
    "timingDate" : "<date>",
    "timingPeriod" : { Period },
    // value[x]: Additional Data or supporting information. One of these 5:
    "valueBoolean" : <boolean>,
    "valueString" : "<string>",
    "valueQuantity" : { Quantity },
    "valueAttachment" : { Attachment },
    "valueReference" : { Reference(Any) },
    "reason" : { CodeableConcept } // Reason associated with the information
  }],
  "diagnosis" : [{ // List of Diagnosis
    "sequence" : "<positiveInt>", // R!  Number to convey order of diagnosis
    // diagnosis[x]: Patient's diagnosis. One of these 2:
    "diagnosisCodeableConcept" : { CodeableConcept },
    "diagnosisReference" : { Reference(Condition) },
    "type" : [{ CodeableConcept }], // Timing or nature of the diagnosis
    "onAdmission" : { CodeableConcept }, // Present on admission

    "packageCode" : { CodeableConcept } // Package billing code
  }],
  "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:
    "procedureCodeableConcept" : { CodeableConcept }
    "procedureReference" : { Reference(Procedure) }
  }],
  "insurance" : [{ // Insurance or medical plan
    "sequence" : "<positiveInt>", // R!  Service instance identifier
    "focal" : <boolean>, // R!  Is the focal Coverage
    "identifier" : { Identifier }, // Claim number
    "coverage" : { Reference(Coverage) }, // R!  Insurance information
    "businessArrangement" : "<string>", // Business agreement
    "preAuthRef" : ["<string>"], // Pre-Authorization/Determination Reference
    "claimResponse" : { Reference(ClaimResponse) } // Adjudication results
  }],
  "accident" : { // Details about an accident
    "date" : "<date>", // R!  When the accident occurred
see information codes
see information codes
    "type" : { CodeableConcept }, // The nature of the accident
    // location[x]: Accident Place. One of these 2:
    "locationAddress" : { Address }
    "locationReference" : { Reference(Location) }
  },
  "item" : [{ // Goods and Services
    "sequence" : "<positiveInt>", // R!  Service instance
    "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 }, // Type of service or product
    "billcode" : { CodeableConcept }, // Billing Code
    "modifier" : [{ CodeableConcept }], // Service/Product billing modifiers

    "programCode" : [{ CodeableConcept }], // 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:
    "locationCodeableConcept" : { CodeableConcept },
    "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
    "

    "net" : { Money }, // Total item cost

    "udi" : [{ Reference(Device) }], // Unique Device Identifier
    "bodySite" : { CodeableConcept }, // Service Location
    "

    "subSite" : [{ CodeableConcept }], // Service Sub-location

    "encounter" : [{ Reference(Encounter) }], // Encounters related to this billed item
    "detail" : [{ // Additional items
      "sequence" : "<positiveInt>", // R!  Service instance
      "
      "
      "
      "

      "revenue" : { CodeableConcept }, // Revenue or cost center code
      "category" : { CodeableConcept }, // Type of service or product
      "billcode" : { CodeableConcept }, // Billing Code
      "modifier" : [{ CodeableConcept }], // Service/Product billing modifiers

      "programCode" : [{ CodeableConcept }], // 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
      "

      "net" : { Money }, // Total additional item cost

      "udi" : [{ Reference(Device) }], // Unique Device Identifier
      "subDetail" : [{ // Additional items
        "sequence" : "<positiveInt>", // R!  Service instance
        "
        "
        "
        "

        "revenue" : { CodeableConcept }, // Revenue or cost center code
        "category" : { CodeableConcept }, // Type of service or product
        "billcode" : { CodeableConcept }, // Billing Code
        "modifier" : [{ CodeableConcept }], // Service/Product billing modifiers

        "programCode" : [{ CodeableConcept }], // 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
        "

        "net" : { Money }, // Net additional item cost

        "udi" : [{ Reference(Device) }] // Unique Device Identifier
      }]
    }]
  }],
  "total" : { Money } // Total claim cost
}

@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 ]; # 0..1 active | cancelled | draft | entered-in-error
  fhir:
  fhir:
  fhir:

  fhir:Claim.type [ CodeableConcept ]; # 0..1 Type or discipline
  fhir:Claim.subType [ CodeableConcept ]; # 0..1 Finer grained claim type information
  fhir:Claim.use [ code ]; # 0..1 claim | preauthorization | predetermination

  fhir:Claim.patient [ Reference(Patient) ]; # 0..1 The subject of the Products and Services
  fhir:Claim.billablePeriod [ Period ]; # 0..1 Period for charge submission
  fhir:

  fhir:Claim.created [ dateTime ]; # 0..1 Creation date

  fhir:Claim.enterer [ Reference(Practitioner|PractitionerRole) ]; # 0..1 Author
  fhir:Claim.insurer [ Reference(Organization) ]; # 0..1 Target
  fhir:Claim.provider [ Reference(Practitioner|PractitionerRole|Organization) ]; # 0..1 Responsible provider
  fhir:Claim.priority [ CodeableConcept ]; # 0..1 Desired processing priority
  fhir:Claim.fundsReserve [ CodeableConcept ]; # 0..1 Funds requested to be reserved
  fhir:

  fhir:Claim.related [ # 0..* Related Claims which may be relevant to processing this claim

    fhir:Claim.related.claim [ Reference(Claim) ]; # 0..1 Reference to the related claim
    fhir:
    fhir:

    fhir:Claim.related.relationship [ CodeableConcept ]; # 0..1 How the reference claim is related
    fhir:Claim.related.reference [ Identifier ]; # 0..1 Related file or case reference

  ], ...;
  fhir:Claim.prescription [ Reference(MedicationRequest|VisionPrescription) ]; # 0..1 Prescription authorizing services or products
  fhir:

  fhir:Claim.originalPrescription [ Reference(MedicationRequest) ]; # 0..1 Original prescription if superseded by fulfiller

  fhir:Claim.payee [ # 0..1 Party to be paid any benefits payable
    fhir:Claim.payee.type [ CodeableConcept ]; # 1..1 Type of party: Subscriber, Provider, other
    fhir:Claim.payee.resource [ Coding ]; # 0..1 organization | patient | practitioner | relatedperson
    fhir:Claim.payee.party [ Reference(Practitioner|PractitionerRole|Organization|Patient|RelatedPerson) ]; # 0..1 Party to receive the payable
  ];
  fhir:Claim.referral [ Reference(ServiceRequest) ]; # 0..1 Treatment Referral
  fhir:Claim.facility [ Reference(Location) ]; # 0..1 Servicing Facility
  fhir:Claim.careTeam [ # 0..* Members of the care team
    fhir:Claim.careTeam.sequence [ positiveInt ]; # 1..1 Number to convey order of careTeam
    fhir:Claim.careTeam.provider [ Reference(Practitioner|PractitionerRole|Organization) ]; # 1..1 Provider individual or organization
    fhir:Claim.careTeam.responsible [ boolean ]; # 0..1 Billing provider
    fhir:

    fhir:Claim.careTeam.role [ CodeableConcept ]; # 0..1 Role on the team

    fhir:Claim.careTeam.qualification [ CodeableConcept ]; # 0..1 Type, classification or Specialization
  ], ...;
  fhir:

  fhir:Claim.information [ # 0..* Exceptions, special considerations, the condition, situation, prior or concurrent issues

    fhir:Claim.information.sequence [ positiveInt ]; # 1..1 Information instance identifier
    fhir:Claim.information.category [ CodeableConcept ]; # 1..1 General class of information
    fhir:Claim.information.code [ CodeableConcept ]; # 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 or supporting information. One of these 5
      fhir:Claim.information.valueBoolean [ boolean ]
      fhir:Claim.information.valueString [ string ]
      fhir:Claim.information.valueQuantity [ Quantity ]
      fhir:Claim.information.valueAttachment [ Attachment ]
      fhir:Claim.information.valueReference [ Reference(Any) ]
    fhir:Claim.information.reason [ CodeableConcept ]; # 0..1 Reason associated with the information
  ], ...;
  fhir:Claim.diagnosis [ # 0..* List of Diagnosis
    fhir:Claim.diagnosis.sequence [ positiveInt ]; # 1..1 Number to convey order of diagnosis
    # Claim.diagnosis.diagnosis[x] : 1..1 Patient's diagnosis. One of these 2
      fhir:Claim.diagnosis.diagnosisCodeableConcept [ CodeableConcept ]
      fhir:Claim.diagnosis.diagnosisReference [ Reference(Condition) ]
    fhir:Claim.diagnosis.type [ CodeableConcept ], ... ; # 0..* Timing or nature of the diagnosis
    fhir:Claim.diagnosis.onAdmission [ CodeableConcept ]; # 0..1 Present on admission

    fhir:Claim.diagnosis.packageCode [ CodeableConcept ]; # 0..1 Package billing code
  ], ...;
  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.procedureCodeableConcept [ CodeableConcept ]
      fhir:Claim.procedure.procedureReference [ Reference(Procedure) ]
  ], ...;
  fhir:Claim.insurance [ # 0..* Insurance or medical plan
    fhir:Claim.insurance.sequence [ positiveInt ]; # 1..1 Service instance identifier
    fhir:Claim.insurance.focal [ boolean ]; # 1..1 Is the focal Coverage
    fhir:Claim.insurance.identifier [ Identifier ]; # 0..1 Claim number
    fhir:Claim.insurance.coverage [ Reference(Coverage) ]; # 1..1 Insurance information
    fhir:Claim.insurance.businessArrangement [ string ]; # 0..1 Business agreement
    fhir:Claim.insurance.preAuthRef [ string ], ... ; # 0..* Pre-Authorization/Determination Reference
    fhir:Claim.insurance.claimResponse [ Reference(ClaimResponse) ]; # 0..1 Adjudication results
  ], ...;
  fhir:Claim.accident [ # 0..1 Details about an accident
    fhir:Claim.accident.date [ date ]; # 1..1 When the accident occurred
see information codes
see information codes
    fhir:Claim.accident.type [ CodeableConcept ]; # 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.item [ # 0..* Goods and Services
    fhir:Claim.item.sequence [ positiveInt ]; # 1..1 Service instance
    fhir:Claim.item.careTeamSequence [ positiveInt ], ... ; # 0..* Applicable careTeam members
    fhir:Claim.item.diagnosisSequence [ positiveInt ], ... ; # 0..* Applicable diagnoses
    fhir:Claim.item.procedureSequence [ positiveInt ], ... ; # 0..* Applicable procedures
    fhir:
    fhir:

    fhir:Claim.item.informationSequence [ positiveInt ], ... ; # 0..* Applicable exception and supporting information
    fhir:Claim.item.revenue [ CodeableConcept ]; # 0..1 Revenue or cost center code

    fhir:Claim.item.category [ CodeableConcept ]; # 0..1 Type of service or product
    fhir:
    fhir:

    fhir:Claim.item.billcode [ CodeableConcept ]; # 0..1 Billing Code
    fhir:Claim.item.modifier [ CodeableConcept ], ... ; # 0..* Service/Product billing modifiers

    fhir:Claim.item.programCode [ CodeableConcept ], ... ; # 0..* Program specific reason for item inclusion
    # . One of these 2
      fhir: ]
      fhir: ]

    # 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.locationCodeableConcept [ CodeableConcept ]
      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:

    fhir:Claim.item.net [ Money ]; # 0..1 Total item cost

    fhir:Claim.item.udi [ Reference(Device) ], ... ; # 0..* Unique Device Identifier
    fhir:Claim.item.bodySite [ CodeableConcept ]; # 0..1 Service Location
    fhir:

    fhir:Claim.item.subSite [ CodeableConcept ], ... ; # 0..* Service Sub-location

    fhir:Claim.item.encounter [ Reference(Encounter) ], ... ; # 0..* Encounters related to this billed item
    fhir:Claim.item.detail [ # 0..* Additional items
      fhir:Claim.item.detail.sequence [ positiveInt ]; # 1..1 Service instance
      fhir:
      fhir:
      fhir:
      fhir:

      fhir:Claim.item.detail.revenue [ CodeableConcept ]; # 0..1 Revenue or cost center code
      fhir:Claim.item.detail.category [ CodeableConcept ]; # 0..1 Type of service or product
      fhir:Claim.item.detail.billcode [ CodeableConcept ]; # 0..1 Billing Code
      fhir:Claim.item.detail.modifier [ CodeableConcept ], ... ; # 0..* Service/Product billing modifiers

      fhir:Claim.item.detail.programCode [ CodeableConcept ], ... ; # 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:

      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:
        fhir:
        fhir:
        fhir:

        fhir:Claim.item.detail.subDetail.revenue [ CodeableConcept ]; # 0..1 Revenue or cost center code
        fhir:Claim.item.detail.subDetail.category [ CodeableConcept ]; # 0..1 Type of service or product
        fhir:Claim.item.detail.subDetail.billcode [ CodeableConcept ]; # 0..1 Billing Code
        fhir:Claim.item.detail.subDetail.modifier [ CodeableConcept ], ... ; # 0..* Service/Product billing modifiers

        fhir:Claim.item.detail.subDetail.programCode [ CodeableConcept ], ... ; # 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:

        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.total [ Money ]; # 0..1 Total claim cost
]

See the Full Difference for further information

This analysis is available as XML or JSON .

See R3 <--> R4 Conversion Maps (status = 16 tests of which 4 fail to execute . 12 fail round-trip testing and 12 r3 resources are invalid (0 errors). )