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13.6 Ресурс Claim - Назначение

Financial Management Work GroupMaturity Level: 2 Trial UseSecurity Category: Patient Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson

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

Ресурс Claim - "требование о страховом возмещении" - используется поставщиками и плательщиками, страховыми компаниями для обмена финансовой информацией и вспомогательной медицинской информацией относительно предоставления услуг здравоохранения со страховыми компаниями, для отчётности в регулирующие органы, и фирмами, которые проводят анализ данных. Основные виды использования этого ресурса: поддержка eClaims - электронных требований о страховом возмещении, обмен информацией, связанной с предложенными или оказанными медицинскими товарами и услугами c плательщиками пособий (benefit payors), страховщиками и национальными программами здравоохранения, планирование оплаты лечения и её компенсации.

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

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

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

Ресурс Claim также поддерживает:

  • До 3 уровней иерархии товаров, продуктов и услуг для выставления простых и сложных счетов.
  • Несколько страховых программ, расположенных в последовательности согласования выгоды (Coordination of Benefit) для работы с первичными, вторичными, третичными и т. д. страховыми покрытиями.
  • Назначение пособия - пособие по запросу может быть направлено абоненту-подписчику (subscriber), поставщику или другой стороне.

Mapping to other Claim specifications: Mappings are currently maintained by the Financial Management Work Group to UB04 and CMS1500 and are available at http://wiki.hl7.org/index.php?title=Financial_Management_FHIR_Resource_Development . Mappings to other specifications may be made available where IP restrictions permit.

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

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

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

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

The eClaim domain includes a number of related resources

Claim A suite of goods and services and insurances coverages under which adjudication or authorization is requested.
ClaimResponse A payor's adjudication and/or authorization response to the suite of services provided in a Claim. Typically the ClaimResponse references the Claim but does not duplicate the clinical or financial information provided in the claim.
ExplanationOfBenefit This resource combines the information from the Claim and the ClaimResponse, stripping out any provider or payor proprietary information, into a unified information model suitable for use for: patient reporting; transferring information to a Patient Health Record system; and, supporting complete claim and adjudication information exchange with regulatory and analytics organizations and other parts of the provider's organization.

На этот ресурс ссылаются itself, ClaimResponse, DeviceUseStatement и ExplanationOfBenefit

Структура

ИмяФлагиКард.ТипОписание и ограниченияdoco
.. Claim TUDomainResourceТребование о страховом возмещении, предварительное определение или предварительное разрешение
Элементы, определённые в прародителе: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierBusiness Identifier for claim
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Financial Resource Status Codes (Required)
... type Σ1..1CodeableConceptCategory or discipline
Claim Type Codes (Extensible)
... subType 0..1CodeableConceptMore granular claim type
Example Claim SubType Codes (Example)
... use Σ1..1codeclaim | preauthorization | predetermination
Use (Required)
... patient Σ1..1Reference(Patient)The recipient of the products and services
... billablePeriod Σ0..1PeriodRelevant time frame for the claim
... created Σ1..1dateTimeResource Дата создания
... enterer 0..1Reference(Practitioner | PractitionerRole)Author of the claim
... insurer Σ0..1Reference(Organization)Целевой адресат
... provider Σ1..1Reference(Practitioner | PractitionerRole | Organization)Party responsible for the claim
... priority Σ1..1CodeableConceptDesired processing ugency
Process Priority Codes (Example)
... fundsReserve 0..1CodeableConceptFor whom to reserve funds
FundsReserve (Example)
... related 0..*BackboneElementPrior or corollary claims
.... claim 0..1Reference(Claim)Ссылка на связанное требование о страховом возмещении
.... relationship 0..1CodeableConceptКак связаны требования о страховом возмещении
Example Related Claim Relationship Codes (Example)
.... reference 0..1IdentifierFile or case reference
... prescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Prescription authorizing services and products
... originalPrescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Original prescription if superseded by fulfiller
... payee 0..1BackboneElementRecipient of benefits payable
.... type 1..1CodeableConceptCategory of recipient
PayeeType (Example)
.... party 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)Recipient reference
... referral 0..1Reference(ServiceRequest)Направление на лечение
... facility 0..1Reference(Location)Обслуживающее учреждение
... careTeam 0..*BackboneElementЧлены команды по уходу
.... sequence 1..1positiveIntOrder of care team
.... provider 1..1Reference(Practitioner | PractitionerRole | Organization)Practitioner or organization
.... responsible 0..1booleanIndicator of the lead practitioner
.... role 0..1CodeableConceptFunction within the team
Claim Care Team Role Codes (Example)
.... qualification 0..1CodeableConceptPractitioner credential or specialization
Example Provider Qualification Codes (Example)
... supportingInfo 0..*BackboneElementSupporting information
.... sequence 1..1positiveIntInformation instance identifier
.... category 1..1CodeableConceptClassification of the supplied information
Claim Information Category Codes (Example)
.... code 0..1CodeableConceptType of information
Exception Codes (Example)
.... timing[x] 0..1When it occurred
..... timingDatedate
..... timingPeriodPeriod
.... value[x] 0..1Data to be provided
..... valueBooleanboolean
..... valueStringstring
..... valueQuantityQuantity
..... valueAttachmentAttachment
..... valueReferenceReference(Any)
.... reason 0..1CodeableConceptExplanation for the information
Missing Tooth Reason Codes (Example)
... diagnosis 0..*BackboneElementPertinent diagnosis information
.... sequence 1..1positiveIntDiagnosis instance identifier
.... diagnosis[x] 1..1Nature of illness or problem
ICD-10 Codes (Example)
..... diagnosisCodeableConceptCodeableConcept
..... diagnosisReferenceReference(Condition)
.... type 0..*CodeableConceptTiming or nature of the diagnosis
Example Diagnosis Type Codes (Example)
.... onAdmission 0..1CodeableConceptPresent on admission
Example Diagnosis on Admission Codes (Example)
.... packageCode 0..1CodeableConceptPackage billing code
Example Diagnosis Related Group Codes (Example)
... procedure 0..*BackboneElementClinical Выполненные процедуры
.... sequence 1..1positiveIntProcedure instance identifier
.... type 0..*CodeableConceptCategory of Procedure
Example Procedure Type Codes (Example)
.... date 0..1dateTimeWhen the procedure was performed
.... procedure[x] 1..1Specific clinical procedure
ICD-10 Procedure Codes (Example)
..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
.... udi 0..*Reference(Device)Уникальный идентификатор устройства (UDI)
... insurance Σ1..*BackboneElementPatient insurance information
.... sequence Σ1..1positiveIntInsurance instance identifier
.... focal Σ1..1booleanCoverage to be used for adjudication
.... identifier 0..1IdentifierPre-assigned Claim number
.... coverage Σ1..1Reference(Coverage)Информация по страховке
.... businessArrangement 0..1stringAdditional provider contract number
.... preAuthRef 0..*stringPrior authorization reference number
.... claimResponse 0..1Reference(ClaimResponse)Результаты вынесения решения
... accident 0..1BackboneElementDetails of the event
.... date 1..1dateWhen the incident occurred
.... type 0..1CodeableConceptТип несчастного случая
V3 Value SetActIncidentCode (Extensible)
.... location[x] 0..1Where the event occurred
..... locationAddressAddress
..... locationReferenceReference(Location)
... item 0..*BackboneElementProduct or service provided
.... sequence 1..1positiveIntItem instance identifier
.... careTeamSequence 0..*positiveIntApplicable careTeam members
.... diagnosisSequence 0..*positiveIntПрименимые диагнозы
.... procedureSequence 0..*positiveIntApplicable procedures
.... informationSequence 0..*positiveIntApplicable exception and supporting information
.... revenue 0..1CodeableConceptRevenue or cost center code
Example Revenue Center Codes (Example)
.... category 0..1CodeableConceptBenefit classification
Benefit Category Codes (Example)
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
USCLS Codes (Example)
.... modifier 0..*CodeableConceptProduct or service billing modifiers
Modifier type Codes (Example)
.... programCode 0..*CodeableConceptProgram the product or service is provided under
Example Program Reason Codes (Example)
.... serviced[x] 0..1Дата или даты оказания услуг or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Example Service Place Codes (Example)
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1SimpleQuantityКоличество продуктов или услуг
.... unitPrice 0..1MoneyFee, charge or cost per item
.... factor 0..1decimalКоэффициент масштабирования цены
.... net 0..1MoneyОбщая стоимость позиции
.... udi 0..*Reference(Device)Уникальный идентификатор устройства (UDI)
.... bodySite 0..1CodeableConceptAnatomical location
Oral Site Codes (Example)
.... subSite 0..*CodeableConceptAnatomical sub-location
Surface Codes (Example)
.... encounter 0..*Reference(Encounter)Encounters related to this billed item
.... detail 0..*BackboneElementProduct or service provided
..... sequence 1..1positiveIntItem instance identifier
..... revenue 0..1CodeableConceptRevenue or cost center code
Example Revenue Center Codes (Example)
..... category 0..1CodeableConceptBenefit classification
Benefit Category Codes (Example)
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
USCLS Codes (Example)
..... modifier 0..*CodeableConceptМодификаторы выставления счёта за услугу/продукт
Modifier type Codes (Example)
..... programCode 0..*CodeableConceptProgram the product or service is provided under
Example Program Reason Codes (Example)
..... quantity 0..1SimpleQuantityКоличество продуктов или услуг
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalКоэффициент масштабирования цены
..... net 0..1MoneyОбщая стоимость позиции
..... udi 0..*Reference(Device)Уникальный идентификатор устройства (UDI)
..... subDetail 0..*BackboneElementProduct or service provided
...... sequence 1..1positiveIntItem instance identifier
...... revenue 0..1CodeableConceptRevenue or cost center code
Example Revenue Center Codes (Example)
...... category 0..1CodeableConceptBenefit classification
Benefit Category Codes (Example)
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
USCLS Codes (Example)
...... modifier 0..*CodeableConceptМодификаторы выставления счёта за услугу/продукт
Modifier type Codes (Example)
...... programCode 0..*CodeableConceptProgram the product or service is provided under
Example Program Reason Codes (Example)
...... quantity 0..1SimpleQuantityКоличество продуктов или услуг
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalКоэффициент масштабирования цены
...... net 0..1MoneyОбщая стоимость позиции
...... udi 0..*Reference(Device)Уникальный идентификатор устройства (UDI)
... total 0..1MoneyОбщая стоимость требования о страховом возмещении

doco Документация по этому формату

UML-диаграмма (Legend)

Claim (DomainResource)A unique identifier assigned to this claimidentifier : Identifier [0..*]The status of the resource instance (this element modifies the meaning of other elements)status : code [1..1] « A code specifying the state of the resource instance. (Strength=Required)FinancialResourceStatusCodes! »Категория требования о страховом возмещении, например стоматология, фармацевтика, офтальмология, институциональная, профессиональнаяtype : CodeableConcept [1..1] « Тип или специализация требования о страховом возмещении. (Strength=Extensible)ClaimTypeCodes+ »A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty servicesubType : CodeableConcept [0..1] « A more granular claim typecode. (Strength=Example)ExampleClaimSubTypeCodes?? »A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the futureuse : code [1..1] « The purpose of the Claim: predetermination, preauthorization, claim. (Strength=Required)Use! »The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimburement is soughtpatient : Reference [1..1] « Patient »The period for which charges are being submittedbillablePeriod : Period [0..1]The date this resource was createdcreated : dateTime [1..1]Individual who created the claim, predetermination or preauthorizationenterer : Reference [0..1] « Practitioner|PractitionerRole »Страховщик, который является объектом запросаinsurer : Reference [0..1] « Organization »Поставщик, который несет ответственность за предварительное определение, предварительное разрешение счёта, требования о страховом возмещенииprovider : Reference [1..1] « Practitioner|PractitionerRole| Organization »The provider-required urgency of processing the request. Typical values include: stat, routine deferredpriority : CodeableConcept [1..1] « Приоритет обработки: безотлагательный, обычный, отложенный. (Strength=Example)ProcessPriorityCodes?? »A code to indicate whether and for whom funds are to be reserved for future claimsfundsReserve : CodeableConcept [0..1] « For whom funds are to be reserved: (Patient, Provider, None). (Strength=Example)Funds Reservation ?? »Предписание для поддержки распределения продуктов коррекции зрения или медикаментовprescription : Reference [0..1] « DeviceRequest|MedicationRequest| VisionPrescription »Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or productsoriginalPrescription : Reference [0..1] « DeviceRequest| MedicationRequest|VisionPrescription »A reference to a referral resourcereferral : Reference [0..1] « ServiceRequest »Объект, где были представлены услугиfacility : Reference [0..1] « Location »The total value of the all the items in the claimtotal : Money [0..1]RelatedClaimReference to a related claimclaim : Reference [0..1] « Claim »A code to convey how the claims are relatedrelationship : CodeableConcept [0..1] « Взаимосвязь между этим требованием о страховом возмещении и связанным требованием о страховом возмещении. (Strength=Example) ExampleRelatedClaimRelationsh...?? »An alternate organizational reference to the case or file to which this particular claim pertainsreference : Identifier [0..1]PayeeТип стороны, которой возмещаются затраты: подписчик, поставщик, другоеtype : CodeableConcept [1..1] « A code for the party to be reimbursed. (Strength=Example)Claim Payee Type ?? »Reference to the individual or organization to whom any payment will be madeparty : Reference [0..1] « Practitioner|PractitionerRole| Organization|Patient|RelatedPerson »CareTeamA number to uniquely identify care team entriessequence : positiveInt [1..1]Член команды, предоставившей услугуprovider : Reference [1..1] « Practitioner|PractitionerRole| Organization »The party who is billing and/or responsible for the claimed products or servicesresponsible : boolean [0..1]The lead, assisting or supervising practitioner and their discipline if a multidisciplinary teamrole : CodeableConcept [0..1] « The role codes for the care team members. (Strength=Example)ClaimCareTeamRoleCodes?? »The qualification of the practitioner which is applicable for this servicequalification : CodeableConcept [0..1] « Provider professional qualifications. (Strength=Example) ExampleProviderQualificationC...?? »SupportingInformationA number to uniquely identify supporting information entriessequence : positiveInt [1..1]The general class of the information supplied: information; exception; accident, employment; onset, etccategory : CodeableConcept [1..1] « The valuset used for additional information category codes. (Strength=Example)ClaimInformationCategoryCodes?? »System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is soughtcode : CodeableConcept [0..1] « The valuset used for additional information codes. (Strength=Example)ExceptionCodes?? »The date when or period to which this information referstiming[x] : Type [0..1] « date|Period »Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the datavalue[x] : Type [0..1] « boolean|string|Quantity|Attachment| Reference(Any) »Provides the reason in the situation where a reason code is required in addition to the contentreason : CodeableConcept [0..1] « Коды причин отсутствия зубов. (Strength=Example)MissingToothReasonCodes?? »DiagnosisA number to uniquely identify diagnosis entriessequence : positiveInt [1..1]The nature of illness or problem in a coded form or as a reference to an external defined Conditiondiagnosis[x] : Type [1..1] « CodeableConcept|Reference(Condition); Example Диагностические коды ICD10. (Strength=Example) ICD-10Codes?? »When the condition was observed or the relative rankingtype : CodeableConcept [0..*] « The type of the diagnosis: admitting, principal, discharge. (Strength=Example)ExampleDiagnosisTypeCodes?? »Indication of whether the diagnosis was present on admission to a facilityonAdmission : CodeableConcept [0..1] « Present on admission. (Strength=Example) ExampleDiagnosisOnAdmissionCo...?? »A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code systempackageCode : CodeableConcept [0..1] « The DRG codes associated with the diagnosis. (Strength=Example) ExampleDiagnosisRelatedGroupC...?? »ProcedureA number to uniquely identify procedure entriessequence : positiveInt [1..1]When the condition was observed or the relative rankingtype : CodeableConcept [0..*] « Example procedure type codes. (Strength=Example)ExampleProcedureTypeCodes?? »Дата и, необязательно, время, когда была выполнена процедураdate : dateTime [0..1]The code or reference to a Procedure resource which identifies the clinical intervention performedprocedure[x] : Type [1..1] « CodeableConcept|Reference(Procedure); Example ICD10 Procedure codes. (Strength=Example) ICD-10ProcedureCodes?? »Unique Device Identifiers associated with this line itemudi : Reference [0..*] « Device »InsuranceA number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit ordersequence : positiveInt [1..1]A flag to indicate that this Coverage is to be used for adjudication of this claim when set to truefocal : boolean [1..1]The business identifier to be used when the claim is sent for adjudication against this insurance policyidentifier : Identifier [0..1]Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information systemcoverage : Reference [1..1] « Coverage »A Деловое соглашениеnumber established between the provider and the insurer for special business processing purposesbusinessArrangement : string [0..1]Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorizationpreAuthRef : string [0..*]The result of the adjudication of the line items for the Coverage specified in this insuranceclaimResponse : Reference [0..1] « ClaimResponse »AccidentDate of an accident event related to the products and services contained in the claimdate : date [1..1]The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurerstype : CodeableConcept [0..1] « Тип несчастного случая: производственный, автомобильная авария и т. д. (Strength=Extensible)v3.ActIncidentCode+ »The physical location of the accident eventlocation[x] : Type [0..1] « Address|Reference(Location) »ItemA number to uniquely identify item entriessequence : positiveInt [1..1]CareTeam members related to this service or productcareTeamSequence : positiveInt [0..*]Diagnoses applicable for this service or productdiagnosisSequence : positiveInt [0..*]Procedures applicable for this service or productprocedureSequence : positiveInt [0..*]Exceptions, special conditions and supporting information applicable for this service or productinformationSequence : positiveInt [0..*]The type of revenue or cost center providing the product and/or servicerevenue : CodeableConcept [0..1] « Codes for the revenue or cost centers supplying the service and/or products. (Strength=Example)ExampleRevenueCenterCodes?? »Code to identify the general type of benefits under which products and services are providedcategory : CodeableConcept [0..1] « Benefit categories such as: oral-basic, major, glasses. (Strength=Example)BenefitCategoryCodes?? »When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the itemproductOrService : CodeableConcept [1..1] « Допустимые коды услуг и продуктов. (Strength=Example)USCLSCodes?? »Item typification or modifiers codes to convey additional context for the product or servicemodifier : CodeableConcept [0..*] « Коды типов пунктов или модификаторов, например для стоматологии, было ли лечение косметическим или связано с TMJ, или было ли утеряно или украдено приспособление. (Strength=Example)ModifierTypeCodes?? »Identifies the program under which this may be recoveredprogramCode : CodeableConcept [0..*] « Коды обоснований, специфичные для программ. (Strength=Example)ExampleProgramReasonCodes?? »The date or dates when the service or product was supplied, performed or completedserviced[x] : Type [0..1] « date|Period »Where the product or service was providedlocation[x] : Type [0..1] « CodeableConcept|Address|Reference( Location); Place of service: pharmacy, school, prison, etc. (Strength=Example)ExampleServicePlaceCodes?? »Число повторений услуги или продуктаquantity : Quantity(SimpleQuantity) [0..1]Если этот пункт является конечным элементом, тогда это плата за продукт или услугу, иначе это общая сумма плат за все пункты из этой группыunitPrice : Money [0..1]Действительное число, которое представляет собой множитель, используемый при определении общей стоимости предоставляемых услуг и/или полученных товаров. Понятие "коэффициент" позволяет применять к денежной сумме множитель скидки или надбавкиfactor : decimal [0..1]The quantity times the unit price for an additional service or product or chargenet : Money [0..1]Unique Device Identifiers associated with this line itemudi : Reference [0..*] « Device »Физическое расположение на пациенте места оказания услуги (конечность, зуб и т. п.)bodySite : CodeableConcept [0..1] « Код зуба, квадрант, секстант и арка. (Strength=Example)OralSiteCodes?? »Участок или поверхность тела, например область конечности или поверхности зубаsubSite : CodeableConcept [0..*] « Код поверхности зуба и комбинаций поверхностей. (Strength=Example)SurfaceCodes?? »The Encounters during which this Claim was created or to which the creation of this record is tightly associatedencounter : Reference [0..*] « Encounter »DetailA number to uniquely identify item entriessequence : positiveInt [1..1]The type of revenue or cost center providing the product and/or servicerevenue : CodeableConcept [0..1] « Codes for the revenue or cost centers supplying the service and/or products. (Strength=Example)ExampleRevenueCenterCodes?? »Code to identify the general type of benefits under which products and services are providedcategory : CodeableConcept [0..1] « Benefit categories such as: oral-basic, major, glasses. (Strength=Example)BenefitCategoryCodes?? »When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the itemproductOrService : CodeableConcept [1..1] « Допустимые коды услуг и продуктов. (Strength=Example)USCLSCodes?? »Item typification or modifiers codes to convey additional context for the product or servicemodifier : CodeableConcept [0..*] « Коды типов пунктов или модификаторов, например для стоматологии, было ли лечение косметическим или связано с TMJ, или было ли утеряно или украдено приспособление. (Strength=Example)ModifierTypeCodes?? »Identifies the program under which this may be recoveredprogramCode : CodeableConcept [0..*] « Коды обоснований, специфичные для программ. (Strength=Example)ExampleProgramReasonCodes?? »Число повторений услуги или продуктаquantity : Quantity(SimpleQuantity) [0..1]Если этот пункт является конечным элементом, тогда это плата за продукт или услугу, иначе это общая сумма плат за все пункты из этой группыunitPrice : Money [0..1]Действительное число, которое представляет собой множитель, используемый при определении общей стоимости предоставляемых услуг и/или полученных товаров. Понятие "коэффициент" позволяет применять к денежной сумме множитель скидки или надбавкиfactor : decimal [0..1]The quantity times the unit price for an additional service or product or chargenet : Money [0..1]Unique Device Identifiers associated with this line itemudi : Reference [0..*] « Device »SubDetailA number to uniquely identify item entriessequence : positiveInt [1..1]The type of revenue or cost center providing the product and/or servicerevenue : CodeableConcept [0..1] « Codes for the revenue or cost centers supplying the service and/or products. (Strength=Example)ExampleRevenueCenterCodes?? »Code to identify the general type of benefits under which products and services are providedcategory : CodeableConcept [0..1] « Benefit categories such as: oral-basic, major, glasses. (Strength=Example)BenefitCategoryCodes?? »When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the itemproductOrService : CodeableConcept [1..1] « Допустимые коды услуг и продуктов. (Strength=Example)USCLSCodes?? »Item typification or modifiers codes to convey additional context for the product or servicemodifier : CodeableConcept [0..*] « Коды типов пунктов или модификаторов, например для стоматологии, было ли лечение косметическим или связано с TMJ, или было ли утеряно или украдено приспособление. (Strength=Example)ModifierTypeCodes?? »Identifies the program under which this may be recoveredprogramCode : CodeableConcept [0..*] « Коды обоснований, специфичные для программ. (Strength=Example)ExampleProgramReasonCodes?? »Число повторений услуги или продуктаquantity : Quantity(SimpleQuantity) [0..1]Если этот пункт является конечным элементом, тогда это плата за продукт или услугу, иначе это общая сумма плат за все пункты из этой группыunitPrice : Money [0..1]Действительное число, которое представляет собой множитель, используемый при определении общей стоимости предоставляемых услуг и/или полученных товаров. Понятие "коэффициент" позволяет применять к денежной сумме множитель скидки или надбавкиfactor : decimal [0..1]The quantity times the unit price for an additional service or product or chargenet : Money [0..1]Unique Device Identifiers associated with this line itemudi : Reference [0..*] « Device »Other claims which are related to this claim such as prior submissions or claims for related services or for the same eventrelated[0..*]The party to be reimbursed for cost of the products and services according to the terms of the policypayee[0..1]The members of the team who provided the products and servicescareTeam[0..*]Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issuessupportingInfo[0..*]Information about diagnoses relevant to the claim itemsdiagnosis[0..*]Procedures performed on the patient relevant to the billing items with the claimprocedure[0..*]Financial instruments for reimbursement for the health care products and services specified on the claiminsurance[1..*]Details of a accident which resulted in injuries which required the products and services listed in the claimaccident[0..1]A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple itemssubDetail[0..*]A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple itemsdetail[0..*]A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-detailsitem[0..*]

XML-шаблон

<Claim xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier for claim --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <type><!-- 1..1 CodeableConcept Category or discipline --></type>
 <subType><!-- 0..1 CodeableConcept More granular claim type --></subType>
 <use value="[code]"/><!-- 1..1 claim | preauthorization | predetermination -->
 <patient><!-- 1..1 Reference(Patient) The recipient of the products and services --></patient>
 <billablePeriod><!-- 0..1 Period Relevant time frame for the claim --></billablePeriod>
 <created value="[dateTime]"/><!-- 1..1 Resource Дата создания -->
 <enterer><!-- 0..1 Reference(Practitioner|PractitionerRole) Author of the claim --></enterer>
 <insurer><!-- 0..1 Reference(Organization) Целевой адресат --></insurer>
 <provider><!-- 1..1 Reference(Practitioner|PractitionerRole|Organization) Party responsible for the claim --></provider>
 <priority><!-- 1..1 CodeableConcept Desired processing ugency --></priority>
 <fundsReserve><!-- 0..1 CodeableConcept For whom to reserve funds --></fundsReserve>
 <related>  <!-- 0..* Prior or corollary claims -->
  <claim><!-- 0..1 Reference(Claim) Ссылка на связанное требование о страховом возмещении --></claim>
  <relationship><!-- 0..1 CodeableConcept Как связаны требования о страховом возмещении --></relationship>
  <reference><!-- 0..1 Identifier File or case reference --></reference>
 </related>
 <prescription><!-- 0..1 Reference(DeviceRequest|MedicationRequest|
   VisionPrescription) Prescription authorizing services and products --></prescription>
 <originalPrescription><!-- 0..1 Reference(DeviceRequest|MedicationRequest|
   VisionPrescription) Original prescription if superseded by fulfiller --></originalPrescription>
 <payee>  <!-- 0..1 Recipient of benefits payable -->
  <type><!-- 1..1 CodeableConcept Category of recipient --></type>
  <party><!-- 0..1 Reference(Practitioner|PractitionerRole|Organization|Patient|
    RelatedPerson) Recipient reference --></party>
 </payee>
 <referral><!-- 0..1 Reference(ServiceRequest) Направление на лечение --></referral>
 <facility><!-- 0..1 Reference(Location) Обслуживающее учреждение --></facility>
 <careTeam>  <!-- 0..* Члены команды по уходу -->
  <sequence value="[positiveInt]"/><!-- 1..1 Order of care team -->
  <provider><!-- 1..1 Reference(Practitioner|PractitionerRole|Organization) Practitioner or organization --></provider>
  <responsible value="[boolean]"/><!-- 0..1 Indicator of the lead practitioner -->
  <role><!-- 0..1 CodeableConcept Function within the team --></role>
  <qualification><!-- 0..1 CodeableConcept Practitioner credential or specialization --></qualification>
 </careTeam>
 <supportingInfo>  <!-- 0..* Supporting information -->
  <sequence value="[positiveInt]"/><!-- 1..1 Information instance identifier -->
  <category><!-- 1..1 CodeableConcept Classification of the supplied 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) Data to be provided --></value[x]>
  <reason><!-- 0..1 CodeableConcept Explanation for the information --></reason>
 </supportingInfo>
 <diagnosis>  <!-- 0..* Pertinent diagnosis information -->
  <sequence value="[positiveInt]"/><!-- 1..1 Diagnosis instance identifier -->
  <diagnosis[x]><!-- 1..1 CodeableConcept|Reference(Condition) Nature of illness or problem --></diagnosis[x]>
  <type><!-- 0..* CodeableConcept Timing or nature of the diagnosis --></type>
  <onAdmission><!-- 0..1 CodeableConcept Present on admission --></onAdmission>
  <packageCode><!-- 0..1 CodeableConcept Package billing code --></packageCode>
 </diagnosis>
 <procedure>  <!-- 0..* Clinical Выполненные процедуры -->
  <sequence value="[positiveInt]"/><!-- 1..1 Procedure instance identifier -->
  <type><!-- 0..* CodeableConcept Category of Procedure --></type>
  <date value="[dateTime]"/><!-- 0..1 When the procedure was performed -->
  <procedure[x]><!-- 1..1 CodeableConcept|Reference(Procedure) Specific clinical procedure --></procedure[x]>
  <udi><!-- 0..* Reference(Device) Уникальный идентификатор устройства (UDI) --></udi>
 </procedure>
 <insurance>  <!-- 1..* Patient insurance information -->
  <sequence value="[positiveInt]"/><!-- 1..1 Insurance instance identifier -->
  <focal value="[boolean]"/><!-- 1..1 Coverage to be used for adjudication -->
  <identifier><!-- 0..1 Identifier Pre-assigned Claim number --></identifier>
  <coverage><!-- 1..1 Reference(Coverage) Информация по страховке --></coverage>
  <businessArrangement value="[string]"/><!-- 0..1 Additional provider contract number -->
  <preAuthRef value="[string]"/><!-- 0..* Prior authorization reference number -->
  <claimResponse><!-- 0..1 Reference(ClaimResponse) Результаты вынесения решения --></claimResponse>
 </insurance>
 <accident>  <!-- 0..1 Details of the event -->
  <date value="[date]"/><!-- 1..1 When the incident occurred -->
  <type><!-- 0..1 CodeableConcept Тип несчастного случая --></type>
  <location[x]><!-- 0..1 Address|Reference(Location) Where the event occurred --></location[x]>
 </accident>
 <item>  <!-- 0..* Product or service provided -->
  <sequence value="[positiveInt]"/><!-- 1..1 Item instance identifier -->
  <careTeamSequence value="[positiveInt]"/><!-- 0..* Applicable careTeam members -->
  <diagnosisSequence value="[positiveInt]"/><!-- 0..* Применимые диагнозы -->
  <procedureSequence value="[positiveInt]"/><!-- 0..* Applicable procedures -->
  <informationSequence value="[positiveInt]"/><!-- 0..* Applicable exception and supporting information -->
  <revenue><!-- 0..1 CodeableConcept Revenue or cost center code --></revenue>
  <category><!-- 0..1 CodeableConcept Benefit classification --></category>
  <productOrService><!-- 1..1 CodeableConcept Billing, service, product, or drug code --></productOrService>
  <modifier><!-- 0..* CodeableConcept Product or service billing modifiers --></modifier>
  <programCode><!-- 0..* CodeableConcept Program the product or service is provided under --></programCode>
  <serviced[x]><!-- 0..1 date|Period Дата или даты оказания услуг or product delivery --></serviced[x]>
  <location[x]><!-- 0..1 CodeableConcept|Address|Reference(Location) Place of service or where product was supplied --></location[x]>
  <quantity><!-- 0..1 Quantity(SimpleQuantity) Количество продуктов или услуг --></quantity>
  <unitPrice><!-- 0..1 Money Fee, charge or cost per item --></unitPrice>
  <factor value="[decimal]"/><!-- 0..1 Коэффициент масштабирования цены -->
  <net><!-- 0..1 Money Общая стоимость позиции --></net>
  <udi><!-- 0..* Reference(Device) Уникальный идентификатор устройства (UDI) --></udi>
  <bodySite><!-- 0..1 CodeableConcept Anatomical location --></bodySite>
  <subSite><!-- 0..* CodeableConcept Anatomical sub-location --></subSite>
  <encounter><!-- 0..* Reference(Encounter) Encounters related to this billed item --></encounter>
  <detail>  <!-- 0..* Product or service provided -->
   <sequence value="[positiveInt]"/><!-- 1..1 Item instance identifier -->
   <revenue><!-- 0..1 CodeableConcept Revenue or cost center code --></revenue>
   <category><!-- 0..1 CodeableConcept Benefit classification --></category>
   <productOrService><!-- 1..1 CodeableConcept Billing, service, product, or drug code --></productOrService>
   <modifier><!-- 0..* CodeableConcept Модификаторы выставления счёта за услугу/продукт --></modifier>
   <programCode><!-- 0..* CodeableConcept Program the product or service is provided under --></programCode>
   <quantity><!-- 0..1 Quantity(SimpleQuantity) Количество продуктов или услуг --></quantity>
   <unitPrice><!-- 0..1 Money Fee, charge or cost per item --></unitPrice>
   <factor value="[decimal]"/><!-- 0..1 Коэффициент масштабирования цены -->
   <net><!-- 0..1 Money Общая стоимость позиции --></net>
   <udi><!-- 0..* Reference(Device) Уникальный идентификатор устройства (UDI) --></udi>
   <subDetail>  <!-- 0..* Product or service provided -->
    <sequence value="[positiveInt]"/><!-- 1..1 Item instance identifier -->
    <revenue><!-- 0..1 CodeableConcept Revenue or cost center code --></revenue>
    <category><!-- 0..1 CodeableConcept Benefit classification --></category>
    <productOrService><!-- 1..1 CodeableConcept Billing, service, product, or drug code --></productOrService>
    <modifier><!-- 0..* CodeableConcept Модификаторы выставления счёта за услугу/продукт --></modifier>
    <programCode><!-- 0..* CodeableConcept Program the product or service is provided under --></programCode>
    <quantity><!-- 0..1 Quantity(SimpleQuantity) Количество продуктов или услуг --></quantity>
    <unitPrice><!-- 0..1 Money Fee, charge or cost per item --></unitPrice>
    <factor value="[decimal]"/><!-- 0..1 Коэффициент масштабирования цены -->
    <net><!-- 0..1 Money Общая стоимость позиции --></net>
    <udi><!-- 0..* Reference(Device) Уникальный идентификатор устройства (UDI) --></udi>
   </subDetail>
  </detail>
 </item>
 <total><!-- 0..1 Money Общая стоимость требования о страховом возмещении --></total>
</Claim>

JSON-шаблон

{doco
  "resourceType" : "Claim",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier for claim
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  "type" : { CodeableConcept }, // R!  Category or discipline
  "subType" : { CodeableConcept }, // More granular claim type
  "use" : "<code>", // R!  claim | preauthorization | predetermination
  "patient" : { Reference(Patient) }, // R!  The recipient of the products and services
  "billablePeriod" : { Period }, // Relevant time frame for the claim
  "created" : "<dateTime>", // R!  Resource Дата создания
  "enterer" : { Reference(Practitioner|PractitionerRole) }, // Author of the claim
  "insurer" : { Reference(Organization) }, // Целевой адресат
  "provider" : { Reference(Practitioner|PractitionerRole|Organization) }, // R!  Party responsible for the claim
  "priority" : { CodeableConcept }, // R!  Desired processing ugency
  "fundsReserve" : { CodeableConcept }, // For whom to reserve funds
  "related" : [{ // Prior or corollary claims
    "claim" : { Reference(Claim) }, // Ссылка на связанное требование о страховом возмещении
    "relationship" : { CodeableConcept }, // Как связаны требования о страховом возмещении
    "reference" : { Identifier } // File or case reference
  }],
  "prescription" : { Reference(DeviceRequest|MedicationRequest|
   VisionPrescription) }, // Prescription authorizing services and products
  "originalPrescription" : { Reference(DeviceRequest|MedicationRequest|
   VisionPrescription) }, // Original prescription if superseded by fulfiller
  "payee" : { // Recipient of benefits payable
    "type" : { CodeableConcept }, // R!  Category of recipient
    "party" : { Reference(Practitioner|PractitionerRole|Organization|Patient|
    RelatedPerson) } // Recipient reference
  },
  "referral" : { Reference(ServiceRequest) }, // Направление на лечение
  "facility" : { Reference(Location) }, // Обслуживающее учреждение
  "careTeam" : [{ // Члены команды по уходу
    "sequence" : "<positiveInt>", // R!  Order of care team
    "provider" : { Reference(Practitioner|PractitionerRole|Organization) }, // R!  Practitioner or organization
    "responsible" : <boolean>, // Indicator of the lead practitioner
    "role" : { CodeableConcept }, // Function within the team
    "qualification" : { CodeableConcept } // Practitioner credential or specialization
  }],
  "supportingInfo" : [{ // Supporting information
    "sequence" : "<positiveInt>", // R!  Information instance identifier
    "category" : { CodeableConcept }, // R!  Classification of the supplied information
    "code" : { CodeableConcept }, // Type of information
    // timing[x]: When it occurred. One of these 2:
    "timingDate" : "<date>",
    "timingPeriod" : { Period },
    // value[x]: Data to be provided. One of these 5:
    "valueBoolean" : <boolean>,
    "valueString" : "<string>",
    "valueQuantity" : { Quantity },
    "valueAttachment" : { Attachment },
    "valueReference" : { Reference(Any) },
    "reason" : { CodeableConcept } // Explanation for the information
  }],
  "diagnosis" : [{ // Pertinent diagnosis information
    "sequence" : "<positiveInt>", // R!  Diagnosis instance identifier
    // diagnosis[x]: Nature of illness or problem. One of these 2:
    "diagnosisCodeableConcept" : { CodeableConcept },
    "diagnosisReference" : { Reference(Condition) },
    "type" : [{ CodeableConcept }], // Timing or nature of the diagnosis
    "onAdmission" : { CodeableConcept }, // Present on admission
    "packageCode" : { CodeableConcept } // Package billing code
  }],
  "procedure" : [{ // Clinical Выполненные процедуры
    "sequence" : "<positiveInt>", // R!  Procedure instance identifier
    "type" : [{ CodeableConcept }], // Category of Procedure
    "date" : "<dateTime>", // When the procedure was performed
    // procedure[x]: Specific clinical procedure. One of these 2:
    "procedureCodeableConcept" : { CodeableConcept },
    "procedureReference" : { Reference(Procedure) },
    "udi" : [{ Reference(Device) }] // Уникальный идентификатор устройства (UDI)
  }],
  "insurance" : [{ // R!  Patient insurance information
    "sequence" : "<positiveInt>", // R!  Insurance instance identifier
    "focal" : <boolean>, // R!  Coverage to be used for adjudication
    "identifier" : { Identifier }, // Pre-assigned Claim number
    "coverage" : { Reference(Coverage) }, // R!  Информация по страховке
    "businessArrangement" : "<string>", // Additional provider contract number
    "preAuthRef" : ["<string>"], // Prior authorization reference number
    "claimResponse" : { Reference(ClaimResponse) } // Результаты вынесения решения
  }],
  "accident" : { // Details of the event
    "date" : "<date>", // R!  When the incident occurred
    "type" : { CodeableConcept }, // Тип несчастного случая
    // location[x]: Where the event occurred. One of these 2:
    "locationAddress" : { Address }
    "locationReference" : { Reference(Location) }
  },
  "item" : [{ // Product or service provided
    "sequence" : "<positiveInt>", // R!  Item instance identifier
    "careTeamSequence" : ["<positiveInt>"], // Applicable careTeam members
    "diagnosisSequence" : ["<positiveInt>"], // Применимые диагнозы
    "procedureSequence" : ["<positiveInt>"], // Applicable procedures
    "informationSequence" : ["<positiveInt>"], // Applicable exception and supporting information
    "revenue" : { CodeableConcept }, // Revenue or cost center code
    "category" : { CodeableConcept }, // Benefit classification
    "productOrService" : { CodeableConcept }, // R!  Billing, service, product, or drug code
    "modifier" : [{ CodeableConcept }], // Product or service billing modifiers
    "programCode" : [{ CodeableConcept }], // Program the product or service is provided under
    // serviced[x]: Дата или даты оказания услуг or product delivery. One of these 2:
    "servicedDate" : "<date>",
    "servicedPeriod" : { Period },
    // location[x]: Place of service or where product was supplied. One of these 3:
    "locationCodeableConcept" : { CodeableConcept },
    "locationAddress" : { Address },
    "locationReference" : { Reference(Location) },
    "quantity" : { Quantity(SimpleQuantity) }, // Количество продуктов или услуг
    "unitPrice" : { Money }, // Fee, charge or cost per item
    "factor" : <decimal>, // Коэффициент масштабирования цены
    "net" : { Money }, // Общая стоимость позиции
    "udi" : [{ Reference(Device) }], // Уникальный идентификатор устройства (UDI)
    "bodySite" : { CodeableConcept }, // Anatomical location
    "subSite" : [{ CodeableConcept }], // Anatomical sub-location
    "encounter" : [{ Reference(Encounter) }], // Encounters related to this billed item
    "detail" : [{ // Product or service provided
      "sequence" : "<positiveInt>", // R!  Item instance identifier
      "revenue" : { CodeableConcept }, // Revenue or cost center code
      "category" : { CodeableConcept }, // Benefit classification
      "productOrService" : { CodeableConcept }, // R!  Billing, service, product, or drug code
      "modifier" : [{ CodeableConcept }], // Модификаторы выставления счёта за услугу/продукт
      "programCode" : [{ CodeableConcept }], // Program the product or service is provided under
      "quantity" : { Quantity(SimpleQuantity) }, // Количество продуктов или услуг
      "unitPrice" : { Money }, // Fee, charge or cost per item
      "factor" : <decimal>, // Коэффициент масштабирования цены
      "net" : { Money }, // Общая стоимость позиции
      "udi" : [{ Reference(Device) }], // Уникальный идентификатор устройства (UDI)
      "subDetail" : [{ // Product or service provided
        "sequence" : "<positiveInt>", // R!  Item instance identifier
        "revenue" : { CodeableConcept }, // Revenue or cost center code
        "category" : { CodeableConcept }, // Benefit classification
        "productOrService" : { CodeableConcept }, // R!  Billing, service, product, or drug code
        "modifier" : [{ CodeableConcept }], // Модификаторы выставления счёта за услугу/продукт
        "programCode" : [{ CodeableConcept }], // Program the product or service is provided under
        "quantity" : { Quantity(SimpleQuantity) }, // Количество продуктов или услуг
        "unitPrice" : { Money }, // Fee, charge or cost per item
        "factor" : <decimal>, // Коэффициент масштабирования цены
        "net" : { Money }, // Общая стоимость позиции
        "udi" : [{ Reference(Device) }] // Уникальный идентификатор устройства (UDI)
      }]
    }]
  }],
  "total" : { Money } // Общая стоимость требования о страховом возмещении
}

Turtle-шаблон

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


[ 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..* Business Identifier for claim
  fhir:Claim.status [ code ]; # 1..1 active | cancelled | draft | entered-in-error
  fhir:Claim.type [ CodeableConcept ]; # 1..1 Category or discipline
  fhir:Claim.subType [ CodeableConcept ]; # 0..1 More granular claim type
  fhir:Claim.use [ code ]; # 1..1 claim | preauthorization | predetermination
  fhir:Claim.patient [ Reference(Patient) ]; # 1..1 The recipient of the products and services
  fhir:Claim.billablePeriod [ Period ]; # 0..1 Relevant time frame for the claim
  fhir:Claim.created [ dateTime ]; # 1..1 Resource Дата создания
  fhir:Claim.enterer [ Reference(Practitioner|PractitionerRole) ]; # 0..1 Author of the claim
  fhir:Claim.insurer [ Reference(Organization) ]; # 0..1 Целевой адресат
  fhir:Claim.provider [ Reference(Practitioner|PractitionerRole|Organization) ]; # 1..1 Party responsible for the claim
  fhir:Claim.priority [ CodeableConcept ]; # 1..1 Desired processing ugency
  fhir:Claim.fundsReserve [ CodeableConcept ]; # 0..1 For whom to reserve funds
  fhir:Claim.related [ # 0..* Prior or corollary claims
    fhir:Claim.related.claim [ Reference(Claim) ]; # 0..1 Ссылка на связанное требование о страховом возмещении
    fhir:Claim.related.relationship [ CodeableConcept ]; # 0..1 Как связаны требования о страховом возмещении
    fhir:Claim.related.reference [ Identifier ]; # 0..1 File or case reference
  ], ...;
  fhir:Claim.prescription [ Reference(DeviceRequest|MedicationRequest|VisionPrescription) ]; # 0..1 Prescription authorizing services and products
  fhir:Claim.originalPrescription [ Reference(DeviceRequest|MedicationRequest|VisionPrescription) ]; # 0..1 Original prescription if superseded by fulfiller
  fhir:Claim.payee [ # 0..1 Recipient of benefits payable
    fhir:Claim.payee.type [ CodeableConcept ]; # 1..1 Category of recipient
    fhir:Claim.payee.party [ Reference(Practitioner|PractitionerRole|Organization|Patient|RelatedPerson) ]; # 0..1 Recipient reference
  ];
  fhir:Claim.referral [ Reference(ServiceRequest) ]; # 0..1 Направление на лечение
  fhir:Claim.facility [ Reference(Location) ]; # 0..1 Обслуживающее учреждение
  fhir:Claim.careTeam [ # 0..* Члены команды по уходу
    fhir:Claim.careTeam.sequence [ positiveInt ]; # 1..1 Order of care team
    fhir:Claim.careTeam.provider [ Reference(Practitioner|PractitionerRole|Organization) ]; # 1..1 Practitioner or organization
    fhir:Claim.careTeam.responsible [ boolean ]; # 0..1 Indicator of the lead practitioner
    fhir:Claim.careTeam.role [ CodeableConcept ]; # 0..1 Function within the team
    fhir:Claim.careTeam.qualification [ CodeableConcept ]; # 0..1 Practitioner credential or specialization
  ], ...;
  fhir:Claim.supportingInfo [ # 0..* Supporting information
    fhir:Claim.supportingInfo.sequence [ positiveInt ]; # 1..1 Information instance identifier
    fhir:Claim.supportingInfo.category [ CodeableConcept ]; # 1..1 Classification of the supplied information
    fhir:Claim.supportingInfo.code [ CodeableConcept ]; # 0..1 Type of information
    # Claim.supportingInfo.timing[x] : 0..1 When it occurred. One of these 2
      fhir:Claim.supportingInfo.timingDate [ date ]
      fhir:Claim.supportingInfo.timingPeriod [ Period ]
    # Claim.supportingInfo.value[x] : 0..1 Data to be provided. One of these 5
      fhir:Claim.supportingInfo.valueBoolean [ boolean ]
      fhir:Claim.supportingInfo.valueString [ string ]
      fhir:Claim.supportingInfo.valueQuantity [ Quantity ]
      fhir:Claim.supportingInfo.valueAttachment [ Attachment ]
      fhir:Claim.supportingInfo.valueReference [ Reference(Any) ]
    fhir:Claim.supportingInfo.reason [ CodeableConcept ]; # 0..1 Explanation for the information
  ], ...;
  fhir:Claim.diagnosis [ # 0..* Pertinent diagnosis information
    fhir:Claim.diagnosis.sequence [ positiveInt ]; # 1..1 Diagnosis instance identifier
    # Claim.diagnosis.diagnosis[x] : 1..1 Nature of illness or problem. 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..* Clinical Выполненные процедуры
    fhir:Claim.procedure.sequence [ positiveInt ]; # 1..1 Procedure instance identifier
    fhir:Claim.procedure.type [ CodeableConcept ], ... ; # 0..* Category of Procedure
    fhir:Claim.procedure.date [ dateTime ]; # 0..1 When the procedure was performed
    # Claim.procedure.procedure[x] : 1..1 Specific clinical procedure. One of these 2
      fhir:Claim.procedure.procedureCodeableConcept [ CodeableConcept ]
      fhir:Claim.procedure.procedureReference [ Reference(Procedure) ]
    fhir:Claim.procedure.udi [ Reference(Device) ], ... ; # 0..* Уникальный идентификатор устройства (UDI)
  ], ...;
  fhir:Claim.insurance [ # 1..* Patient insurance information
    fhir:Claim.insurance.sequence [ positiveInt ]; # 1..1 Insurance instance identifier
    fhir:Claim.insurance.focal [ boolean ]; # 1..1 Coverage to be used for adjudication
    fhir:Claim.insurance.identifier [ Identifier ]; # 0..1 Pre-assigned Claim number
    fhir:Claim.insurance.coverage [ Reference(Coverage) ]; # 1..1 Информация по страховке
    fhir:Claim.insurance.businessArrangement [ string ]; # 0..1 Additional provider contract number
    fhir:Claim.insurance.preAuthRef [ string ], ... ; # 0..* Prior authorization reference number
    fhir:Claim.insurance.claimResponse [ Reference(ClaimResponse) ]; # 0..1 Результаты вынесения решения
  ], ...;
  fhir:Claim.accident [ # 0..1 Details of the event
    fhir:Claim.accident.date [ date ]; # 1..1 When the incident occurred
    fhir:Claim.accident.type [ CodeableConcept ]; # 0..1 Тип несчастного случая
    # Claim.accident.location[x] : 0..1 Where the event occurred. One of these 2
      fhir:Claim.accident.locationAddress [ Address ]
      fhir:Claim.accident.locationReference [ Reference(Location) ]
  ];
  fhir:Claim.item [ # 0..* Product or service provided
    fhir:Claim.item.sequence [ positiveInt ]; # 1..1 Item instance identifier
    fhir:Claim.item.careTeamSequence [ positiveInt ], ... ; # 0..* Applicable careTeam members
    fhir:Claim.item.diagnosisSequence [ positiveInt ], ... ; # 0..* Применимые диагнозы
    fhir:Claim.item.procedureSequence [ positiveInt ], ... ; # 0..* Applicable procedures
    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 Benefit classification
    fhir:Claim.item.productOrService [ CodeableConcept ]; # 1..1 Billing, service, product, or drug code
    fhir:Claim.item.modifier [ CodeableConcept ], ... ; # 0..* Product or service billing modifiers
    fhir:Claim.item.programCode [ CodeableConcept ], ... ; # 0..* Program the product or service is provided under
    # Claim.item.serviced[x] : 0..1 Дата или даты оказания услуг or product delivery. One of these 2
      fhir:Claim.item.servicedDate [ date ]
      fhir:Claim.item.servicedPeriod [ Period ]
    # Claim.item.location[x] : 0..1 Place of service or where product was supplied. 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 Количество продуктов или услуг
    fhir:Claim.item.unitPrice [ Money ]; # 0..1 Fee, charge or cost per item
    fhir:Claim.item.factor [ decimal ]; # 0..1 Коэффициент масштабирования цены
    fhir:Claim.item.net [ Money ]; # 0..1 Общая стоимость позиции
    fhir:Claim.item.udi [ Reference(Device) ], ... ; # 0..* Уникальный идентификатор устройства (UDI)
    fhir:Claim.item.bodySite [ CodeableConcept ]; # 0..1 Anatomical location
    fhir:Claim.item.subSite [ CodeableConcept ], ... ; # 0..* Anatomical sub-location
    fhir:Claim.item.encounter [ Reference(Encounter) ], ... ; # 0..* Encounters related to this billed item
    fhir:Claim.item.detail [ # 0..* Product or service provided
      fhir:Claim.item.detail.sequence [ positiveInt ]; # 1..1 Item instance identifier
      fhir:Claim.item.detail.revenue [ CodeableConcept ]; # 0..1 Revenue or cost center code
      fhir:Claim.item.detail.category [ CodeableConcept ]; # 0..1 Benefit classification
      fhir:Claim.item.detail.productOrService [ CodeableConcept ]; # 1..1 Billing, service, product, or drug code
      fhir:Claim.item.detail.modifier [ CodeableConcept ], ... ; # 0..* Модификаторы выставления счёта за услугу/продукт
      fhir:Claim.item.detail.programCode [ CodeableConcept ], ... ; # 0..* Program the product or service is provided under
      fhir:Claim.item.detail.quantity [ Quantity(SimpleQuantity) ]; # 0..1 Количество продуктов или услуг
      fhir:Claim.item.detail.unitPrice [ Money ]; # 0..1 Fee, charge or cost per item
      fhir:Claim.item.detail.factor [ decimal ]; # 0..1 Коэффициент масштабирования цены
      fhir:Claim.item.detail.net [ Money ]; # 0..1 Общая стоимость позиции
      fhir:Claim.item.detail.udi [ Reference(Device) ], ... ; # 0..* Уникальный идентификатор устройства (UDI)
      fhir:Claim.item.detail.subDetail [ # 0..* Product or service provided
        fhir:Claim.item.detail.subDetail.sequence [ positiveInt ]; # 1..1 Item instance identifier
        fhir:Claim.item.detail.subDetail.revenue [ CodeableConcept ]; # 0..1 Revenue or cost center code
        fhir:Claim.item.detail.subDetail.category [ CodeableConcept ]; # 0..1 Benefit classification
        fhir:Claim.item.detail.subDetail.productOrService [ CodeableConcept ]; # 1..1 Billing, service, product, or drug code
        fhir:Claim.item.detail.subDetail.modifier [ CodeableConcept ], ... ; # 0..* Модификаторы выставления счёта за услугу/продукт
        fhir:Claim.item.detail.subDetail.programCode [ CodeableConcept ], ... ; # 0..* Program the product or service is provided under
        fhir:Claim.item.detail.subDetail.quantity [ Quantity(SimpleQuantity) ]; # 0..1 Количество продуктов или услуг
        fhir:Claim.item.detail.subDetail.unitPrice [ Money ]; # 0..1 Fee, charge or cost per item
        fhir:Claim.item.detail.subDetail.factor [ decimal ]; # 0..1 Коэффициент масштабирования цены
        fhir:Claim.item.detail.subDetail.net [ Money ]; # 0..1 Общая стоимость позиции
        fhir:Claim.item.detail.subDetail.udi [ Reference(Device) ], ... ; # 0..* Уникальный идентификатор устройства (UDI)
      ], ...;
    ], ...;
  ], ...;
  fhir:Claim.total [ Money ]; # 0..1 Общая стоимость требования о страховом возмещении
]

Changes since R3

Claim
Claim.status
  • Min Cardinality changed from 0 to 1
Claim.type
  • Min Cardinality changed from 0 to 1
  • Change binding strength from required to extensible
Claim.subType
  • Max Cardinality changed from * to 1
Claim.use
  • Min Cardinality changed from 0 to 1
  • Remove Codes complete, proposed, exploratory, other
  • Add Codes claim, preauthorization, predetermination
Claim.patient
  • Min Cardinality changed from 0 to 1
Claim.created
  • Min Cardinality changed from 0 to 1
Claim.enterer
  • Type Reference: Added Target Type PractitionerRole
Claim.provider
  • Min Cardinality changed from 0 to 1
  • Type Reference: Added Target Types PractitionerRole, Organization
Claim.priority
  • Min Cardinality changed from 0 to 1
Claim.prescription
  • Type Reference: Added Target Type DeviceRequest
Claim.originalPrescription
  • Type Reference: Added Target Types DeviceRequest, VisionPrescription
Claim.payee.party
  • Type Reference: Added Target Type PractitionerRole
Claim.referral
  • Type Reference: Added Target Type ServiceRequest
  • Type Reference: Removed Target Type ReferralRequest
Claim.careTeam.provider
  • Type Reference: Added Target Type PractitionerRole
Claim.supportingInfo
  • Added Element
Claim.supportingInfo.sequence
  • Added Mandatory Element
Claim.supportingInfo.category
  • Added Mandatory Element
Claim.supportingInfo.code
  • Added Element
Claim.supportingInfo.timing[x]
  • Added Element
Claim.supportingInfo.value[x]
  • Added Element
Claim.supportingInfo.reason
  • Added Element
Claim.diagnosis.onAdmission
  • Added Element
Claim.procedure.type
  • Added Element
Claim.procedure.udi
  • Added Element
Claim.insurance
  • Min Cardinality changed from 0 to 1
Claim.insurance.identifier
  • Added Element
Claim.accident.type
  • Change binding strength from required to extensible
Claim.item.careTeamSequence
  • Added Element
Claim.item.diagnosisSequence
  • Added Element
Claim.item.procedureSequence
  • Added Element
Claim.item.informationSequence
  • Added Element
Claim.item.productOrService
  • Added Mandatory Element
Claim.item.detail.productOrService
  • Added Mandatory Element
Claim.item.detail.subDetail.productOrService
  • Added Mandatory Element
Claim.organization
  • deleted
Claim.payee.resourceType
  • deleted
Claim.information
  • deleted
Claim.employmentImpacted
  • deleted
Claim.hospitalization
  • deleted
Claim.item.careTeamLinkId
  • deleted
Claim.item.diagnosisLinkId
  • deleted
Claim.item.procedureLinkId
  • deleted
Claim.item.informationLinkId
  • deleted
Claim.item.service
  • deleted
Claim.item.detail.service
  • deleted
Claim.item.detail.subDetail.service
  • deleted

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 3 fail to execute. 13 fail round-trip testing and 1 r3 resources are invalid (0 errors).)

Структура

ИмяФлагиКард.ТипОписание и ограниченияdoco
.. Claim TUDomainResourceТребование о страховом возмещении, предварительное определение или предварительное разрешение
Элементы, определённые в прародителе: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierBusiness Identifier for claim
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Financial Resource Status Codes (Required)
... type Σ1..1CodeableConceptCategory or discipline
Claim Type Codes (Extensible)
... subType 0..1CodeableConceptMore granular claim type
Example Claim SubType Codes (Example)
... use Σ1..1codeclaim | preauthorization | predetermination
Use (Required)
... patient Σ1..1Reference(Patient)The recipient of the products and services
... billablePeriod Σ0..1PeriodRelevant time frame for the claim
... created Σ1..1dateTimeResource Дата создания
... enterer 0..1Reference(Practitioner | PractitionerRole)Author of the claim
... insurer Σ0..1Reference(Organization)Целевой адресат
... provider Σ1..1Reference(Practitioner | PractitionerRole | Organization)Party responsible for the claim
... priority Σ1..1CodeableConceptDesired processing ugency
Process Priority Codes (Example)
... fundsReserve 0..1CodeableConceptFor whom to reserve funds
FundsReserve (Example)
... related 0..*BackboneElementPrior or corollary claims
.... claim 0..1Reference(Claim)Ссылка на связанное требование о страховом возмещении
.... relationship 0..1CodeableConceptКак связаны требования о страховом возмещении
Example Related Claim Relationship Codes (Example)
.... reference 0..1IdentifierFile or case reference
... prescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Prescription authorizing services and products
... originalPrescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Original prescription if superseded by fulfiller
... payee 0..1BackboneElementRecipient of benefits payable
.... type 1..1CodeableConceptCategory of recipient
PayeeType (Example)
.... party 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)Recipient reference
... referral 0..1Reference(ServiceRequest)Направление на лечение
... facility 0..1Reference(Location)Обслуживающее учреждение
... careTeam 0..*BackboneElementЧлены команды по уходу
.... sequence 1..1positiveIntOrder of care team
.... provider 1..1Reference(Practitioner | PractitionerRole | Organization)Practitioner or organization
.... responsible 0..1booleanIndicator of the lead practitioner
.... role 0..1CodeableConceptFunction within the team
Claim Care Team Role Codes (Example)
.... qualification 0..1CodeableConceptPractitioner credential or specialization
Example Provider Qualification Codes (Example)
... supportingInfo 0..*BackboneElementSupporting information
.... sequence 1..1positiveIntInformation instance identifier
.... category 1..1CodeableConceptClassification of the supplied information
Claim Information Category Codes (Example)
.... code 0..1CodeableConceptType of information
Exception Codes (Example)
.... timing[x] 0..1When it occurred
..... timingDatedate
..... timingPeriodPeriod
.... value[x] 0..1Data to be provided
..... valueBooleanboolean
..... valueStringstring
..... valueQuantityQuantity
..... valueAttachmentAttachment
..... valueReferenceReference(Any)
.... reason 0..1CodeableConceptExplanation for the information
Missing Tooth Reason Codes (Example)
... diagnosis 0..*BackboneElementPertinent diagnosis information
.... sequence 1..1positiveIntDiagnosis instance identifier
.... diagnosis[x] 1..1Nature of illness or problem
ICD-10 Codes (Example)
..... diagnosisCodeableConceptCodeableConcept
..... diagnosisReferenceReference(Condition)
.... type 0..*CodeableConceptTiming or nature of the diagnosis
Example Diagnosis Type Codes (Example)
.... onAdmission 0..1CodeableConceptPresent on admission
Example Diagnosis on Admission Codes (Example)
.... packageCode 0..1CodeableConceptPackage billing code
Example Diagnosis Related Group Codes (Example)
... procedure 0..*BackboneElementClinical Выполненные процедуры
.... sequence 1..1positiveIntProcedure instance identifier
.... type 0..*CodeableConceptCategory of Procedure
Example Procedure Type Codes (Example)
.... date 0..1dateTimeWhen the procedure was performed
.... procedure[x] 1..1Specific clinical procedure
ICD-10 Procedure Codes (Example)
..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
.... udi 0..*Reference(Device)Уникальный идентификатор устройства (UDI)
... insurance Σ1..*BackboneElementPatient insurance information
.... sequence Σ1..1positiveIntInsurance instance identifier
.... focal Σ1..1booleanCoverage to be used for adjudication
.... identifier 0..1IdentifierPre-assigned Claim number
.... coverage Σ1..1Reference(Coverage)Информация по страховке
.... businessArrangement 0..1stringAdditional provider contract number
.... preAuthRef 0..*stringPrior authorization reference number
.... claimResponse 0..1Reference(ClaimResponse)Результаты вынесения решения
... accident 0..1BackboneElementDetails of the event
.... date 1..1dateWhen the incident occurred
.... type 0..1CodeableConceptТип несчастного случая
V3 Value SetActIncidentCode (Extensible)
.... location[x] 0..1Where the event occurred
..... locationAddressAddress
..... locationReferenceReference(Location)
... item 0..*BackboneElementProduct or service provided
.... sequence 1..1positiveIntItem instance identifier
.... careTeamSequence 0..*positiveIntApplicable careTeam members
.... diagnosisSequence 0..*positiveIntПрименимые диагнозы
.... procedureSequence 0..*positiveIntApplicable procedures
.... informationSequence 0..*positiveIntApplicable exception and supporting information
.... revenue 0..1CodeableConceptRevenue or cost center code
Example Revenue Center Codes (Example)
.... category 0..1CodeableConceptBenefit classification
Benefit Category Codes (Example)
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
USCLS Codes (Example)
.... modifier 0..*CodeableConceptProduct or service billing modifiers
Modifier type Codes (Example)
.... programCode 0..*CodeableConceptProgram the product or service is provided under
Example Program Reason Codes (Example)
.... serviced[x] 0..1Дата или даты оказания услуг or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Example Service Place Codes (Example)
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1SimpleQuantityКоличество продуктов или услуг
.... unitPrice 0..1MoneyFee, charge or cost per item
.... factor 0..1decimalКоэффициент масштабирования цены
.... net 0..1MoneyОбщая стоимость позиции
.... udi 0..*Reference(Device)Уникальный идентификатор устройства (UDI)
.... bodySite 0..1CodeableConceptAnatomical location
Oral Site Codes (Example)
.... subSite 0..*CodeableConceptAnatomical sub-location
Surface Codes (Example)
.... encounter 0..*Reference(Encounter)Encounters related to this billed item
.... detail 0..*BackboneElementProduct or service provided
..... sequence 1..1positiveIntItem instance identifier
..... revenue 0..1CodeableConceptRevenue or cost center code
Example Revenue Center Codes (Example)
..... category 0..1CodeableConceptBenefit classification
Benefit Category Codes (Example)
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
USCLS Codes (Example)
..... modifier 0..*CodeableConceptМодификаторы выставления счёта за услугу/продукт
Modifier type Codes (Example)
..... programCode 0..*CodeableConceptProgram the product or service is provided under
Example Program Reason Codes (Example)
..... quantity 0..1SimpleQuantityКоличество продуктов или услуг
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalКоэффициент масштабирования цены
..... net 0..1MoneyОбщая стоимость позиции
..... udi 0..*Reference(Device)Уникальный идентификатор устройства (UDI)
..... subDetail 0..*BackboneElementProduct or service provided
...... sequence 1..1positiveIntItem instance identifier
...... revenue 0..1CodeableConceptRevenue or cost center code
Example Revenue Center Codes (Example)
...... category 0..1CodeableConceptBenefit classification
Benefit Category Codes (Example)
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
USCLS Codes (Example)
...... modifier 0..*CodeableConceptМодификаторы выставления счёта за услугу/продукт
Modifier type Codes (Example)
...... programCode 0..*CodeableConceptProgram the product or service is provided under
Example Program Reason Codes (Example)
...... quantity 0..1SimpleQuantityКоличество продуктов или услуг
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalКоэффициент масштабирования цены
...... net 0..1MoneyОбщая стоимость позиции
...... udi 0..*Reference(Device)Уникальный идентификатор устройства (UDI)
... total 0..1MoneyОбщая стоимость требования о страховом возмещении

doco Документация по этому формату

UML-диаграмма (Legend)

Claim (DomainResource)A unique identifier assigned to this claimidentifier : Identifier [0..*]The status of the resource instance (this element modifies the meaning of other elements)status : code [1..1] « A code specifying the state of the resource instance. (Strength=Required)FinancialResourceStatusCodes! »Категория требования о страховом возмещении, например стоматология, фармацевтика, офтальмология, институциональная, профессиональнаяtype : CodeableConcept [1..1] « Тип или специализация требования о страховом возмещении. (Strength=Extensible)ClaimTypeCodes+ »A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty servicesubType : CodeableConcept [0..1] « A more granular claim typecode. (Strength=Example)ExampleClaimSubTypeCodes?? »A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the futureuse : code [1..1] « The purpose of the Claim: predetermination, preauthorization, claim. (Strength=Required)Use! »The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimburement is soughtpatient : Reference [1..1] « Patient »The period for which charges are being submittedbillablePeriod : Period [0..1]The date this resource was createdcreated : dateTime [1..1]Individual who created the claim, predetermination or preauthorizationenterer : Reference [0..1] « Practitioner|PractitionerRole »Страховщик, который является объектом запросаinsurer : Reference [0..1] « Organization »Поставщик, который несет ответственность за предварительное определение, предварительное разрешение счёта, требования о страховом возмещенииprovider : Reference [1..1] « Practitioner|PractitionerRole| Organization »The provider-required urgency of processing the request. Typical values include: stat, routine deferredpriority : CodeableConcept [1..1] « Приоритет обработки: безотлагательный, обычный, отложенный. (Strength=Example)ProcessPriorityCodes?? »A code to indicate whether and for whom funds are to be reserved for future claimsfundsReserve : CodeableConcept [0..1] « For whom funds are to be reserved: (Patient, Provider, None). (Strength=Example)Funds Reservation ?? »Предписание для поддержки распределения продуктов коррекции зрения или медикаментовprescription : Reference [0..1] « DeviceRequest|MedicationRequest| VisionPrescription »Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or productsoriginalPrescription : Reference [0..1] « DeviceRequest| MedicationRequest|VisionPrescription »A reference to a referral resourcereferral : Reference [0..1] « ServiceRequest »Объект, где были представлены услугиfacility : Reference [0..1] « Location »The total value of the all the items in the claimtotal : Money [0..1]RelatedClaimReference to a related claimclaim : Reference [0..1] « Claim »A code to convey how the claims are relatedrelationship : CodeableConcept [0..1] « Взаимосвязь между этим требованием о страховом возмещении и связанным требованием о страховом возмещении. (Strength=Example) ExampleRelatedClaimRelationsh...?? »An alternate organizational reference to the case or file to which this particular claim pertainsreference : Identifier [0..1]PayeeТип стороны, которой возмещаются затраты: подписчик, поставщик, другоеtype : CodeableConcept [1..1] « A code for the party to be reimbursed. (Strength=Example)Claim Payee Type ?? »Reference to the individual or organization to whom any payment will be madeparty : Reference [0..1] « Practitioner|PractitionerRole| Organization|Patient|RelatedPerson »CareTeamA number to uniquely identify care team entriessequence : positiveInt [1..1]Член команды, предоставившей услугуprovider : Reference [1..1] « Practitioner|PractitionerRole| Organization »The party who is billing and/or responsible for the claimed products or servicesresponsible : boolean [0..1]The lead, assisting or supervising practitioner and their discipline if a multidisciplinary teamrole : CodeableConcept [0..1] « The role codes for the care team members. (Strength=Example)ClaimCareTeamRoleCodes?? »The qualification of the practitioner which is applicable for this servicequalification : CodeableConcept [0..1] « Provider professional qualifications. (Strength=Example) ExampleProviderQualificationC...?? »SupportingInformationA number to uniquely identify supporting information entriessequence : positiveInt [1..1]The general class of the information supplied: information; exception; accident, employment; onset, etccategory : CodeableConcept [1..1] « The valuset used for additional information category codes. (Strength=Example)ClaimInformationCategoryCodes?? »System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is soughtcode : CodeableConcept [0..1] « The valuset used for additional information codes. (Strength=Example)ExceptionCodes?? »The date when or period to which this information referstiming[x] : Type [0..1] « date|Period »Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the datavalue[x] : Type [0..1] « boolean|string|Quantity|Attachment| Reference(Any) »Provides the reason in the situation where a reason code is required in addition to the contentreason : CodeableConcept [0..1] « Коды причин отсутствия зубов. (Strength=Example)MissingToothReasonCodes?? »DiagnosisA number to uniquely identify diagnosis entriessequence : positiveInt [1..1]The nature of illness or problem in a coded form or as a reference to an external defined Conditiondiagnosis[x] : Type [1..1] « CodeableConcept|Reference(Condition); Example Диагностические коды ICD10. (Strength=Example) ICD-10Codes?? »When the condition was observed or the relative rankingtype : CodeableConcept [0..*] « The type of the diagnosis: admitting, principal, discharge. (Strength=Example)ExampleDiagnosisTypeCodes?? »Indication of whether the diagnosis was present on admission to a facilityonAdmission : CodeableConcept [0..1] « Present on admission. (Strength=Example) ExampleDiagnosisOnAdmissionCo...?? »A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code systempackageCode : CodeableConcept [0..1] « The DRG codes associated with the diagnosis. (Strength=Example) ExampleDiagnosisRelatedGroupC...?? »ProcedureA number to uniquely identify procedure entriessequence : positiveInt [1..1]When the condition was observed or the relative rankingtype : CodeableConcept [0..*] « Example procedure type codes. (Strength=Example)ExampleProcedureTypeCodes?? »Дата и, необязательно, время, когда была выполнена процедураdate : dateTime [0..1]The code or reference to a Procedure resource which identifies the clinical intervention performedprocedure[x] : Type [1..1] « CodeableConcept|Reference(Procedure); Example ICD10 Procedure codes. (Strength=Example) ICD-10ProcedureCodes?? »Unique Device Identifiers associated with this line itemudi : Reference [0..*] « Device »InsuranceA number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit ordersequence : positiveInt [1..1]A flag to indicate that this Coverage is to be used for adjudication of this claim when set to truefocal : boolean [1..1]The business identifier to be used when the claim is sent for adjudication against this insurance policyidentifier : Identifier [0..1]Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information systemcoverage : Reference [1..1] « Coverage »A Деловое соглашениеnumber established between the provider and the insurer for special business processing purposesbusinessArrangement : string [0..1]Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorizationpreAuthRef : string [0..*]The result of the adjudication of the line items for the Coverage specified in this insuranceclaimResponse : Reference [0..1] « ClaimResponse »AccidentDate of an accident event related to the products and services contained in the claimdate : date [1..1]The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurerstype : CodeableConcept [0..1] « Тип несчастного случая: производственный, автомобильная авария и т. д. (Strength=Extensible)v3.ActIncidentCode+ »The physical location of the accident eventlocation[x] : Type [0..1] « Address|Reference(Location) »ItemA number to uniquely identify item entriessequence : positiveInt [1..1]CareTeam members related to this service or productcareTeamSequence : positiveInt [0..*]Diagnoses applicable for this service or productdiagnosisSequence : positiveInt [0..*]Procedures applicable for this service or productprocedureSequence : positiveInt [0..*]Exceptions, special conditions and supporting information applicable for this service or productinformationSequence : positiveInt [0..*]The type of revenue or cost center providing the product and/or servicerevenue : CodeableConcept [0..1] « Codes for the revenue or cost centers supplying the service and/or products. (Strength=Example)ExampleRevenueCenterCodes?? »Code to identify the general type of benefits under which products and services are providedcategory : CodeableConcept [0..1] « Benefit categories such as: oral-basic, major, glasses. (Strength=Example)BenefitCategoryCodes?? »When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the itemproductOrService : CodeableConcept [1..1] « Допустимые коды услуг и продуктов. (Strength=Example)USCLSCodes?? »Item typification or modifiers codes to convey additional context for the product or servicemodifier : CodeableConcept [0..*] « Коды типов пунктов или модификаторов, например для стоматологии, было ли лечение косметическим или связано с TMJ, или было ли утеряно или украдено приспособление. (Strength=Example)ModifierTypeCodes?? »Identifies the program under which this may be recoveredprogramCode : CodeableConcept [0..*] « Коды обоснований, специфичные для программ. (Strength=Example)ExampleProgramReasonCodes?? »The date or dates when the service or product was supplied, performed or completedserviced[x] : Type [0..1] « date|Period »Where the product or service was providedlocation[x] : Type [0..1] « CodeableConcept|Address|Reference( Location); Place of service: pharmacy, school, prison, etc. (Strength=Example)ExampleServicePlaceCodes?? »Число повторений услуги или продуктаquantity : Quantity(SimpleQuantity) [0..1]Если этот пункт является конечным элементом, тогда это плата за продукт или услугу, иначе это общая сумма плат за все пункты из этой группыunitPrice : Money [0..1]Действительное число, которое представляет собой множитель, используемый при определении общей стоимости предоставляемых услуг и/или полученных товаров. Понятие "коэффициент" позволяет применять к денежной сумме множитель скидки или надбавкиfactor : decimal [0..1]The quantity times the unit price for an additional service or product or chargenet : Money [0..1]Unique Device Identifiers associated with this line itemudi : Reference [0..*] « Device »Физическое расположение на пациенте места оказания услуги (конечность, зуб и т. п.)bodySite : CodeableConcept [0..1] « Код зуба, квадрант, секстант и арка. (Strength=Example)OralSiteCodes?? »Участок или поверхность тела, например область конечности или поверхности зубаsubSite : CodeableConcept [0..*] « Код поверхности зуба и комбинаций поверхностей. (Strength=Example)SurfaceCodes?? »The Encounters during which this Claim was created or to which the creation of this record is tightly associatedencounter : Reference [0..*] « Encounter »DetailA number to uniquely identify item entriessequence : positiveInt [1..1]The type of revenue or cost center providing the product and/or servicerevenue : CodeableConcept [0..1] « Codes for the revenue or cost centers supplying the service and/or products. (Strength=Example)ExampleRevenueCenterCodes?? »Code to identify the general type of benefits under which products and services are providedcategory : CodeableConcept [0..1] « Benefit categories such as: oral-basic, major, glasses. (Strength=Example)BenefitCategoryCodes?? »When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the itemproductOrService : CodeableConcept [1..1] « Допустимые коды услуг и продуктов. (Strength=Example)USCLSCodes?? »Item typification or modifiers codes to convey additional context for the product or servicemodifier : CodeableConcept [0..*] « Коды типов пунктов или модификаторов, например для стоматологии, было ли лечение косметическим или связано с TMJ, или было ли утеряно или украдено приспособление. (Strength=Example)ModifierTypeCodes?? »Identifies the program under which this may be recoveredprogramCode : CodeableConcept [0..*] « Коды обоснований, специфичные для программ. (Strength=Example)ExampleProgramReasonCodes?? »Число повторений услуги или продуктаquantity : Quantity(SimpleQuantity) [0..1]Если этот пункт является конечным элементом, тогда это плата за продукт или услугу, иначе это общая сумма плат за все пункты из этой группыunitPrice : Money [0..1]Действительное число, которое представляет собой множитель, используемый при определении общей стоимости предоставляемых услуг и/или полученных товаров. Понятие "коэффициент" позволяет применять к денежной сумме множитель скидки или надбавкиfactor : decimal [0..1]The quantity times the unit price for an additional service or product or chargenet : Money [0..1]Unique Device Identifiers associated with this line itemudi : Reference [0..*] « Device »SubDetailA number to uniquely identify item entriessequence : positiveInt [1..1]The type of revenue or cost center providing the product and/or servicerevenue : CodeableConcept [0..1] « Codes for the revenue or cost centers supplying the service and/or products. (Strength=Example)ExampleRevenueCenterCodes?? »Code to identify the general type of benefits under which products and services are providedcategory : CodeableConcept [0..1] « Benefit categories such as: oral-basic, major, glasses. (Strength=Example)BenefitCategoryCodes?? »When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the itemproductOrService : CodeableConcept [1..1] « Допустимые коды услуг и продуктов. (Strength=Example)USCLSCodes?? »Item typification or modifiers codes to convey additional context for the product or servicemodifier : CodeableConcept [0..*] « Коды типов пунктов или модификаторов, например для стоматологии, было ли лечение косметическим или связано с TMJ, или было ли утеряно или украдено приспособление. (Strength=Example)ModifierTypeCodes?? »Identifies the program under which this may be recoveredprogramCode : CodeableConcept [0..*] « Коды обоснований, специфичные для программ. (Strength=Example)ExampleProgramReasonCodes?? »Число повторений услуги или продуктаquantity : Quantity(SimpleQuantity) [0..1]Если этот пункт является конечным элементом, тогда это плата за продукт или услугу, иначе это общая сумма плат за все пункты из этой группыunitPrice : Money [0..1]Действительное число, которое представляет собой множитель, используемый при определении общей стоимости предоставляемых услуг и/или полученных товаров. Понятие "коэффициент" позволяет применять к денежной сумме множитель скидки или надбавкиfactor : decimal [0..1]The quantity times the unit price for an additional service or product or chargenet : Money [0..1]Unique Device Identifiers associated with this line itemudi : Reference [0..*] « Device »Other claims which are related to this claim such as prior submissions or claims for related services or for the same eventrelated[0..*]The party to be reimbursed for cost of the products and services according to the terms of the policypayee[0..1]The members of the team who provided the products and servicescareTeam[0..*]Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issuessupportingInfo[0..*]Information about diagnoses relevant to the claim itemsdiagnosis[0..*]Procedures performed on the patient relevant to the billing items with the claimprocedure[0..*]Financial instruments for reimbursement for the health care products and services specified on the claiminsurance[1..*]Details of a accident which resulted in injuries which required the products and services listed in the claimaccident[0..1]A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple itemssubDetail[0..*]A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple itemsdetail[0..*]A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-detailsitem[0..*]

XML-шаблон

<Claim xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier for claim --></identifier>
 <status value="[code]"/><!-- 1..1 active | cancelled | draft | entered-in-error -->
 <type><!-- 1..1 CodeableConcept Category or discipline --></type>
 <subType><!-- 0..1 CodeableConcept More granular claim type --></subType>
 <use value="[code]"/><!-- 1..1 claim | preauthorization | predetermination -->
 <patient><!-- 1..1 Reference(Patient) The recipient of the products and services --></patient>
 <billablePeriod><!-- 0..1 Period Relevant time frame for the claim --></billablePeriod>
 <created value="[dateTime]"/><!-- 1..1 Resource Дата создания -->
 <enterer><!-- 0..1 Reference(Practitioner|PractitionerRole) Author of the claim --></enterer>
 <insurer><!-- 0..1 Reference(Organization) Целевой адресат --></insurer>
 <provider><!-- 1..1 Reference(Practitioner|PractitionerRole|Organization) Party responsible for the claim --></provider>
 <priority><!-- 1..1 CodeableConcept Desired processing ugency --></priority>
 <fundsReserve><!-- 0..1 CodeableConcept For whom to reserve funds --></fundsReserve>
 <related>  <!-- 0..* Prior or corollary claims -->
  <claim><!-- 0..1 Reference(Claim) Ссылка на связанное требование о страховом возмещении --></claim>
  <relationship><!-- 0..1 CodeableConcept Как связаны требования о страховом возмещении --></relationship>
  <reference><!-- 0..1 Identifier File or case reference --></reference>
 </related>
 <prescription><!-- 0..1 Reference(DeviceRequest|MedicationRequest|
   VisionPrescription) Prescription authorizing services and products --></prescription>
 <originalPrescription><!-- 0..1 Reference(DeviceRequest|MedicationRequest|
   VisionPrescription) Original prescription if superseded by fulfiller --></originalPrescription>
 <payee>  <!-- 0..1 Recipient of benefits payable -->
  <type><!-- 1..1 CodeableConcept Category of recipient --></type>
  <party><!-- 0..1 Reference(Practitioner|PractitionerRole|Organization|Patient|
    RelatedPerson) Recipient reference --></party>
 </payee>
 <referral><!-- 0..1 Reference(ServiceRequest) Направление на лечение --></referral>
 <facility><!-- 0..1 Reference(Location) Обслуживающее учреждение --></facility>
 <careTeam>  <!-- 0..* Члены команды по уходу -->
  <sequence value="[positiveInt]"/><!-- 1..1 Order of care team -->
  <provider><!-- 1..1 Reference(Practitioner|PractitionerRole|Organization) Practitioner or organization --></provider>
  <responsible value="[boolean]"/><!-- 0..1 Indicator of the lead practitioner -->
  <role><!-- 0..1 CodeableConcept Function within the team --></role>
  <qualification><!-- 0..1 CodeableConcept Practitioner credential or specialization --></qualification>
 </careTeam>
 <supportingInfo>  <!-- 0..* Supporting information -->
  <sequence value="[positiveInt]"/><!-- 1..1 Information instance identifier -->
  <category><!-- 1..1 CodeableConcept Classification of the supplied 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) Data to be provided --></value[x]>
  <reason><!-- 0..1 CodeableConcept Explanation for the information --></reason>
 </supportingInfo>
 <diagnosis>  <!-- 0..* Pertinent diagnosis information -->
  <sequence value="[positiveInt]"/><!-- 1..1 Diagnosis instance identifier -->
  <diagnosis[x]><!-- 1..1 CodeableConcept|Reference(Condition) Nature of illness or problem --></diagnosis[x]>
  <type><!-- 0..* CodeableConcept Timing or nature of the diagnosis --></type>
  <onAdmission><!-- 0..1 CodeableConcept Present on admission --></onAdmission>
  <packageCode><!-- 0..1 CodeableConcept Package billing code --></packageCode>
 </diagnosis>
 <procedure>  <!-- 0..* Clinical Выполненные процедуры -->
  <sequence value="[positiveInt]"/><!-- 1..1 Procedure instance identifier -->
  <type><!-- 0..* CodeableConcept Category of Procedure --></type>
  <date value="[dateTime]"/><!-- 0..1 When the procedure was performed -->
  <procedure[x]><!-- 1..1 CodeableConcept|Reference(Procedure) Specific clinical procedure --></procedure[x]>
  <udi><!-- 0..* Reference(Device) Уникальный идентификатор устройства (UDI) --></udi>
 </procedure>
 <insurance>  <!-- 1..* Patient insurance information -->
  <sequence value="[positiveInt]"/><!-- 1..1 Insurance instance identifier -->
  <focal value="[boolean]"/><!-- 1..1 Coverage to be used for adjudication -->
  <identifier><!-- 0..1 Identifier Pre-assigned Claim number --></identifier>
  <coverage><!-- 1..1 Reference(Coverage) Информация по страховке --></coverage>
  <businessArrangement value="[string]"/><!-- 0..1 Additional provider contract number -->
  <preAuthRef value="[string]"/><!-- 0..* Prior authorization reference number -->
  <claimResponse><!-- 0..1 Reference(ClaimResponse) Результаты вынесения решения --></claimResponse>
 </insurance>
 <accident>  <!-- 0..1 Details of the event -->
  <date value="[date]"/><!-- 1..1 When the incident occurred -->
  <type><!-- 0..1 CodeableConcept Тип несчастного случая --></type>
  <location[x]><!-- 0..1 Address|Reference(Location) Where the event occurred --></location[x]>
 </accident>
 <item>  <!-- 0..* Product or service provided -->
  <sequence value="[positiveInt]"/><!-- 1..1 Item instance identifier -->
  <careTeamSequence value="[positiveInt]"/><!-- 0..* Applicable careTeam members -->
  <diagnosisSequence value="[positiveInt]"/><!-- 0..* Применимые диагнозы -->
  <procedureSequence value="[positiveInt]"/><!-- 0..* Applicable procedures -->
  <informationSequence value="[positiveInt]"/><!-- 0..* Applicable exception and supporting information -->
  <revenue><!-- 0..1 CodeableConcept Revenue or cost center code --></revenue>
  <category><!-- 0..1 CodeableConcept Benefit classification --></category>
  <productOrService><!-- 1..1 CodeableConcept Billing, service, product, or drug code --></productOrService>
  <modifier><!-- 0..* CodeableConcept Product or service billing modifiers --></modifier>
  <programCode><!-- 0..* CodeableConcept Program the product or service is provided under --></programCode>
  <serviced[x]><!-- 0..1 date|Period Дата или даты оказания услуг or product delivery --></serviced[x]>
  <location[x]><!-- 0..1 CodeableConcept|Address|Reference(Location) Place of service or where product was supplied --></location[x]>
  <quantity><!-- 0..1 Quantity(SimpleQuantity) Количество продуктов или услуг --></quantity>
  <unitPrice><!-- 0..1 Money Fee, charge or cost per item --></unitPrice>
  <factor value="[decimal]"/><!-- 0..1 Коэффициент масштабирования цены -->
  <net><!-- 0..1 Money Общая стоимость позиции --></net>
  <udi><!-- 0..* Reference(Device) Уникальный идентификатор устройства (UDI) --></udi>
  <bodySite><!-- 0..1 CodeableConcept Anatomical location --></bodySite>
  <subSite><!-- 0..* CodeableConcept Anatomical sub-location --></subSite>
  <encounter><!-- 0..* Reference(Encounter) Encounters related to this billed item --></encounter>
  <detail>  <!-- 0..* Product or service provided -->
   <sequence value="[positiveInt]"/><!-- 1..1 Item instance identifier -->
   <revenue><!-- 0..1 CodeableConcept Revenue or cost center code --></revenue>
   <category><!-- 0..1 CodeableConcept Benefit classification --></category>
   <productOrService><!-- 1..1 CodeableConcept Billing, service, product, or drug code --></productOrService>
   <modifier><!-- 0..* CodeableConcept Модификаторы выставления счёта за услугу/продукт --></modifier>
   <programCode><!-- 0..* CodeableConcept Program the product or service is provided under --></programCode>
   <quantity><!-- 0..1 Quantity(SimpleQuantity) Количество продуктов или услуг --></quantity>
   <unitPrice><!-- 0..1 Money Fee, charge or cost per item --></unitPrice>
   <factor value="[decimal]"/><!-- 0..1 Коэффициент масштабирования цены -->
   <net><!-- 0..1 Money Общая стоимость позиции --></net>
   <udi><!-- 0..* Reference(Device) Уникальный идентификатор устройства (UDI) --></udi>
   <subDetail>  <!-- 0..* Product or service provided -->
    <sequence value="[positiveInt]"/><!-- 1..1 Item instance identifier -->
    <revenue><!-- 0..1 CodeableConcept Revenue or cost center code --></revenue>
    <category><!-- 0..1 CodeableConcept Benefit classification --></category>
    <productOrService><!-- 1..1 CodeableConcept Billing, service, product, or drug code --></productOrService>
    <modifier><!-- 0..* CodeableConcept Модификаторы выставления счёта за услугу/продукт --></modifier>
    <programCode><!-- 0..* CodeableConcept Program the product or service is provided under --></programCode>
    <quantity><!-- 0..1 Quantity(SimpleQuantity) Количество продуктов или услуг --></quantity>
    <unitPrice><!-- 0..1 Money Fee, charge or cost per item --></unitPrice>
    <factor value="[decimal]"/><!-- 0..1 Коэффициент масштабирования цены -->
    <net><!-- 0..1 Money Общая стоимость позиции --></net>
    <udi><!-- 0..* Reference(Device) Уникальный идентификатор устройства (UDI) --></udi>
   </subDetail>
  </detail>
 </item>
 <total><!-- 0..1 Money Общая стоимость требования о страховом возмещении --></total>
</Claim>

JSON-шаблон

{doco
  "resourceType" : "Claim",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier for claim
  "status" : "<code>", // R!  active | cancelled | draft | entered-in-error
  "type" : { CodeableConcept }, // R!  Category or discipline
  "subType" : { CodeableConcept }, // More granular claim type
  "use" : "<code>", // R!  claim | preauthorization | predetermination
  "patient" : { Reference(Patient) }, // R!  The recipient of the products and services
  "billablePeriod" : { Period }, // Relevant time frame for the claim
  "created" : "<dateTime>", // R!  Resource Дата создания
  "enterer" : { Reference(Practitioner|PractitionerRole) }, // Author of the claim
  "insurer" : { Reference(Organization) }, // Целевой адресат
  "provider" : { Reference(Practitioner|PractitionerRole|Organization) }, // R!  Party responsible for the claim
  "priority" : { CodeableConcept }, // R!  Desired processing ugency
  "fundsReserve" : { CodeableConcept }, // For whom to reserve funds
  "related" : [{ // Prior or corollary claims
    "claim" : { Reference(Claim) }, // Ссылка на связанное требование о страховом возмещении
    "relationship" : { CodeableConcept }, // Как связаны требования о страховом возмещении
    "reference" : { Identifier } // File or case reference
  }],
  "prescription" : { Reference(DeviceRequest|MedicationRequest|
   VisionPrescription) }, // Prescription authorizing services and products
  "originalPrescription" : { Reference(DeviceRequest|MedicationRequest|
   VisionPrescription) }, // Original prescription if superseded by fulfiller
  "payee" : { // Recipient of benefits payable
    "type" : { CodeableConcept }, // R!  Category of recipient
    "party" : { Reference(Practitioner|PractitionerRole|Organization|Patient|
    RelatedPerson) } // Recipient reference
  },
  "referral" : { Reference(ServiceRequest) }, // Направление на лечение
  "facility" : { Reference(Location) }, // Обслуживающее учреждение
  "careTeam" : [{ // Члены команды по уходу
    "sequence" : "<positiveInt>", // R!  Order of care team
    "provider" : { Reference(Practitioner|PractitionerRole|Organization) }, // R!  Practitioner or organization
    "responsible" : <boolean>, // Indicator of the lead practitioner
    "role" : { CodeableConcept }, // Function within the team
    "qualification" : { CodeableConcept } // Practitioner credential or specialization
  }],
  "supportingInfo" : [{ // Supporting information
    "sequence" : "<positiveInt>", // R!  Information instance identifier
    "category" : { CodeableConcept }, // R!  Classification of the supplied information
    "code" : { CodeableConcept }, // Type of information
    // timing[x]: When it occurred. One of these 2:
    "timingDate" : "<date>",
    "timingPeriod" : { Period },
    // value[x]: Data to be provided. One of these 5:
    "valueBoolean" : <boolean>,
    "valueString" : "<string>",
    "valueQuantity" : { Quantity },
    "valueAttachment" : { Attachment },
    "valueReference" : { Reference(Any) },
    "reason" : { CodeableConcept } // Explanation for the information
  }],
  "diagnosis" : [{ // Pertinent diagnosis information
    "sequence" : "<positiveInt>", // R!  Diagnosis instance identifier
    // diagnosis[x]: Nature of illness or problem. One of these 2:
    "diagnosisCodeableConcept" : { CodeableConcept },
    "diagnosisReference" : { Reference(Condition) },
    "type" : [{ CodeableConcept }], // Timing or nature of the diagnosis
    "onAdmission" : { CodeableConcept }, // Present on admission
    "packageCode" : { CodeableConcept } // Package billing code
  }],
  "procedure" : [{ // Clinical Выполненные процедуры
    "sequence" : "<positiveInt>", // R!  Procedure instance identifier
    "type" : [{ CodeableConcept }], // Category of Procedure
    "date" : "<dateTime>", // When the procedure was performed
    // procedure[x]: Specific clinical procedure. One of these 2:
    "procedureCodeableConcept" : { CodeableConcept },
    "procedureReference" : { Reference(Procedure) },
    "udi" : [{ Reference(Device) }] // Уникальный идентификатор устройства (UDI)
  }],
  "insurance" : [{ // R!  Patient insurance information
    "sequence" : "<positiveInt>", // R!  Insurance instance identifier
    "focal" : <boolean>, // R!  Coverage to be used for adjudication
    "identifier" : { Identifier }, // Pre-assigned Claim number
    "coverage" : { Reference(Coverage) }, // R!  Информация по страховке
    "businessArrangement" : "<string>", // Additional provider contract number
    "preAuthRef" : ["<string>"], // Prior authorization reference number
    "claimResponse" : { Reference(ClaimResponse) } // Результаты вынесения решения
  }],
  "accident" : { // Details of the event
    "date" : "<date>", // R!  When the incident occurred
    "type" : { CodeableConcept }, // Тип несчастного случая
    // location[x]: Where the event occurred. One of these 2:
    "locationAddress" : { Address }
    "locationReference" : { Reference(Location) }
  },
  "item" : [{ // Product or service provided
    "sequence" : "<positiveInt>", // R!  Item instance identifier
    "careTeamSequence" : ["<positiveInt>"], // Applicable careTeam members
    "diagnosisSequence" : ["<positiveInt>"], // Применимые диагнозы
    "procedureSequence" : ["<positiveInt>"], // Applicable procedures
    "informationSequence" : ["<positiveInt>"], // Applicable exception and supporting information
    "revenue" : { CodeableConcept }, // Revenue or cost center code
    "category" : { CodeableConcept }, // Benefit classification
    "productOrService" : { CodeableConcept }, // R!  Billing, service, product, or drug code
    "modifier" : [{ CodeableConcept }], // Product or service billing modifiers
    "programCode" : [{ CodeableConcept }], // Program the product or service is provided under
    // serviced[x]: Дата или даты оказания услуг or product delivery. One of these 2:
    "servicedDate" : "<date>",
    "servicedPeriod" : { Period },
    // location[x]: Place of service or where product was supplied. One of these 3:
    "locationCodeableConcept" : { CodeableConcept },
    "locationAddress" : { Address },
    "locationReference" : { Reference(Location) },
    "quantity" : { Quantity(SimpleQuantity) }, // Количество продуктов или услуг
    "unitPrice" : { Money }, // Fee, charge or cost per item
    "factor" : <decimal>, // Коэффициент масштабирования цены
    "net" : { Money }, // Общая стоимость позиции
    "udi" : [{ Reference(Device) }], // Уникальный идентификатор устройства (UDI)
    "bodySite" : { CodeableConcept }, // Anatomical location
    "subSite" : [{ CodeableConcept }], // Anatomical sub-location
    "encounter" : [{ Reference(Encounter) }], // Encounters related to this billed item
    "detail" : [{ // Product or service provided
      "sequence" : "<positiveInt>", // R!  Item instance identifier
      "revenue" : { CodeableConcept }, // Revenue or cost center code
      "category" : { CodeableConcept }, // Benefit classification
      "productOrService" : { CodeableConcept }, // R!  Billing, service, product, or drug code
      "modifier" : [{ CodeableConcept }], // Модификаторы выставления счёта за услугу/продукт
      "programCode" : [{ CodeableConcept }], // Program the product or service is provided under
      "quantity" : { Quantity(SimpleQuantity) }, // Количество продуктов или услуг
      "unitPrice" : { Money }, // Fee, charge or cost per item
      "factor" : <decimal>, // Коэффициент масштабирования цены
      "net" : { Money }, // Общая стоимость позиции
      "udi" : [{ Reference(Device) }], // Уникальный идентификатор устройства (UDI)
      "subDetail" : [{ // Product or service provided
        "sequence" : "<positiveInt>", // R!  Item instance identifier
        "revenue" : { CodeableConcept }, // Revenue or cost center code
        "category" : { CodeableConcept }, // Benefit classification
        "productOrService" : { CodeableConcept }, // R!  Billing, service, product, or drug code
        "modifier" : [{ CodeableConcept }], // Модификаторы выставления счёта за услугу/продукт
        "programCode" : [{ CodeableConcept }], // Program the product or service is provided under
        "quantity" : { Quantity(SimpleQuantity) }, // Количество продуктов или услуг
        "unitPrice" : { Money }, // Fee, charge or cost per item
        "factor" : <decimal>, // Коэффициент масштабирования цены
        "net" : { Money }, // Общая стоимость позиции
        "udi" : [{ Reference(Device) }] // Уникальный идентификатор устройства (UDI)
      }]
    }]
  }],
  "total" : { Money } // Общая стоимость требования о страховом возмещении
}

Turtle-шаблон

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


[ 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..* Business Identifier for claim
  fhir:Claim.status [ code ]; # 1..1 active | cancelled | draft | entered-in-error
  fhir:Claim.type [ CodeableConcept ]; # 1..1 Category or discipline
  fhir:Claim.subType [ CodeableConcept ]; # 0..1 More granular claim type
  fhir:Claim.use [ code ]; # 1..1 claim | preauthorization | predetermination
  fhir:Claim.patient [ Reference(Patient) ]; # 1..1 The recipient of the products and services
  fhir:Claim.billablePeriod [ Period ]; # 0..1 Relevant time frame for the claim
  fhir:Claim.created [ dateTime ]; # 1..1 Resource Дата создания
  fhir:Claim.enterer [ Reference(Practitioner|PractitionerRole) ]; # 0..1 Author of the claim
  fhir:Claim.insurer [ Reference(Organization) ]; # 0..1 Целевой адресат
  fhir:Claim.provider [ Reference(Practitioner|PractitionerRole|Organization) ]; # 1..1 Party responsible for the claim
  fhir:Claim.priority [ CodeableConcept ]; # 1..1 Desired processing ugency
  fhir:Claim.fundsReserve [ CodeableConcept ]; # 0..1 For whom to reserve funds
  fhir:Claim.related [ # 0..* Prior or corollary claims
    fhir:Claim.related.claim [ Reference(Claim) ]; # 0..1 Ссылка на связанное требование о страховом возмещении
    fhir:Claim.related.relationship [ CodeableConcept ]; # 0..1 Как связаны требования о страховом возмещении
    fhir:Claim.related.reference [ Identifier ]; # 0..1 File or case reference
  ], ...;
  fhir:Claim.prescription [ Reference(DeviceRequest|MedicationRequest|VisionPrescription) ]; # 0..1 Prescription authorizing services and products
  fhir:Claim.originalPrescription [ Reference(DeviceRequest|MedicationRequest|VisionPrescription) ]; # 0..1 Original prescription if superseded by fulfiller
  fhir:Claim.payee [ # 0..1 Recipient of benefits payable
    fhir:Claim.payee.type [ CodeableConcept ]; # 1..1 Category of recipient
    fhir:Claim.payee.party [ Reference(Practitioner|PractitionerRole|Organization|Patient|RelatedPerson) ]; # 0..1 Recipient reference
  ];
  fhir:Claim.referral [ Reference(ServiceRequest) ]; # 0..1 Направление на лечение
  fhir:Claim.facility [ Reference(Location) ]; # 0..1 Обслуживающее учреждение
  fhir:Claim.careTeam [ # 0..* Члены команды по уходу
    fhir:Claim.careTeam.sequence [ positiveInt ]; # 1..1 Order of care team
    fhir:Claim.careTeam.provider [ Reference(Practitioner|PractitionerRole|Organization) ]; # 1..1 Practitioner or organization
    fhir:Claim.careTeam.responsible [ boolean ]; # 0..1 Indicator of the lead practitioner
    fhir:Claim.careTeam.role [ CodeableConcept ]; # 0..1 Function within the team
    fhir:Claim.careTeam.qualification [ CodeableConcept ]; # 0..1 Practitioner credential or specialization
  ], ...;
  fhir:Claim.supportingInfo [ # 0..* Supporting information
    fhir:Claim.supportingInfo.sequence [ positiveInt ]; # 1..1 Information instance identifier
    fhir:Claim.supportingInfo.category [ CodeableConcept ]; # 1..1 Classification of the supplied information
    fhir:Claim.supportingInfo.code [ CodeableConcept ]; # 0..1 Type of information
    # Claim.supportingInfo.timing[x] : 0..1 When it occurred. One of these 2
      fhir:Claim.supportingInfo.timingDate [ date ]
      fhir:Claim.supportingInfo.timingPeriod [ Period ]
    # Claim.supportingInfo.value[x] : 0..1 Data to be provided. One of these 5
      fhir:Claim.supportingInfo.valueBoolean [ boolean ]
      fhir:Claim.supportingInfo.valueString [ string ]
      fhir:Claim.supportingInfo.valueQuantity [ Quantity ]
      fhir:Claim.supportingInfo.valueAttachment [ Attachment ]
      fhir:Claim.supportingInfo.valueReference [ Reference(Any) ]
    fhir:Claim.supportingInfo.reason [ CodeableConcept ]; # 0..1 Explanation for the information
  ], ...;
  fhir:Claim.diagnosis [ # 0..* Pertinent diagnosis information
    fhir:Claim.diagnosis.sequence [ positiveInt ]; # 1..1 Diagnosis instance identifier
    # Claim.diagnosis.diagnosis[x] : 1..1 Nature of illness or problem. 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..* Clinical Выполненные процедуры
    fhir:Claim.procedure.sequence [ positiveInt ]; # 1..1 Procedure instance identifier
    fhir:Claim.procedure.type [ CodeableConcept ], ... ; # 0..* Category of Procedure
    fhir:Claim.procedure.date [ dateTime ]; # 0..1 When the procedure was performed
    # Claim.procedure.procedure[x] : 1..1 Specific clinical procedure. One of these 2
      fhir:Claim.procedure.procedureCodeableConcept [ CodeableConcept ]
      fhir:Claim.procedure.procedureReference [ Reference(Procedure) ]
    fhir:Claim.procedure.udi [ Reference(Device) ], ... ; # 0..* Уникальный идентификатор устройства (UDI)
  ], ...;
  fhir:Claim.insurance [ # 1..* Patient insurance information
    fhir:Claim.insurance.sequence [ positiveInt ]; # 1..1 Insurance instance identifier
    fhir:Claim.insurance.focal [ boolean ]; # 1..1 Coverage to be used for adjudication
    fhir:Claim.insurance.identifier [ Identifier ]; # 0..1 Pre-assigned Claim number
    fhir:Claim.insurance.coverage [ Reference(Coverage) ]; # 1..1 Информация по страховке
    fhir:Claim.insurance.businessArrangement [ string ]; # 0..1 Additional provider contract number
    fhir:Claim.insurance.preAuthRef [ string ], ... ; # 0..* Prior authorization reference number
    fhir:Claim.insurance.claimResponse [ Reference(ClaimResponse) ]; # 0..1 Результаты вынесения решения
  ], ...;
  fhir:Claim.accident [ # 0..1 Details of the event
    fhir:Claim.accident.date [ date ]; # 1..1 When the incident occurred
    fhir:Claim.accident.type [ CodeableConcept ]; # 0..1 Тип несчастного случая
    # Claim.accident.location[x] : 0..1 Where the event occurred. One of these 2
      fhir:Claim.accident.locationAddress [ Address ]
      fhir:Claim.accident.locationReference [ Reference(Location) ]
  ];
  fhir:Claim.item [ # 0..* Product or service provided
    fhir:Claim.item.sequence [ positiveInt ]; # 1..1 Item instance identifier
    fhir:Claim.item.careTeamSequence [ positiveInt ], ... ; # 0..* Applicable careTeam members
    fhir:Claim.item.diagnosisSequence [ positiveInt ], ... ; # 0..* Применимые диагнозы
    fhir:Claim.item.procedureSequence [ positiveInt ], ... ; # 0..* Applicable procedures
    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 Benefit classification
    fhir:Claim.item.productOrService [ CodeableConcept ]; # 1..1 Billing, service, product, or drug code
    fhir:Claim.item.modifier [ CodeableConcept ], ... ; # 0..* Product or service billing modifiers
    fhir:Claim.item.programCode [ CodeableConcept ], ... ; # 0..* Program the product or service is provided under
    # Claim.item.serviced[x] : 0..1 Дата или даты оказания услуг or product delivery. One of these 2
      fhir:Claim.item.servicedDate [ date ]
      fhir:Claim.item.servicedPeriod [ Period ]
    # Claim.item.location[x] : 0..1 Place of service or where product was supplied. 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 Количество продуктов или услуг
    fhir:Claim.item.unitPrice [ Money ]; # 0..1 Fee, charge or cost per item
    fhir:Claim.item.factor [ decimal ]; # 0..1 Коэффициент масштабирования цены
    fhir:Claim.item.net [ Money ]; # 0..1 Общая стоимость позиции
    fhir:Claim.item.udi [ Reference(Device) ], ... ; # 0..* Уникальный идентификатор устройства (UDI)
    fhir:Claim.item.bodySite [ CodeableConcept ]; # 0..1 Anatomical location
    fhir:Claim.item.subSite [ CodeableConcept ], ... ; # 0..* Anatomical sub-location
    fhir:Claim.item.encounter [ Reference(Encounter) ], ... ; # 0..* Encounters related to this billed item
    fhir:Claim.item.detail [ # 0..* Product or service provided
      fhir:Claim.item.detail.sequence [ positiveInt ]; # 1..1 Item instance identifier
      fhir:Claim.item.detail.revenue [ CodeableConcept ]; # 0..1 Revenue or cost center code
      fhir:Claim.item.detail.category [ CodeableConcept ]; # 0..1 Benefit classification
      fhir:Claim.item.detail.productOrService [ CodeableConcept ]; # 1..1 Billing, service, product, or drug code
      fhir:Claim.item.detail.modifier [ CodeableConcept ], ... ; # 0..* Модификаторы выставления счёта за услугу/продукт
      fhir:Claim.item.detail.programCode [ CodeableConcept ], ... ; # 0..* Program the product or service is provided under
      fhir:Claim.item.detail.quantity [ Quantity(SimpleQuantity) ]; # 0..1 Количество продуктов или услуг
      fhir:Claim.item.detail.unitPrice [ Money ]; # 0..1 Fee, charge or cost per item
      fhir:Claim.item.detail.factor [ decimal ]; # 0..1 Коэффициент масштабирования цены
      fhir:Claim.item.detail.net [ Money ]; # 0..1 Общая стоимость позиции
      fhir:Claim.item.detail.udi [ Reference(Device) ], ... ; # 0..* Уникальный идентификатор устройства (UDI)
      fhir:Claim.item.detail.subDetail [ # 0..* Product or service provided
        fhir:Claim.item.detail.subDetail.sequence [ positiveInt ]; # 1..1 Item instance identifier
        fhir:Claim.item.detail.subDetail.revenue [ CodeableConcept ]; # 0..1 Revenue or cost center code
        fhir:Claim.item.detail.subDetail.category [ CodeableConcept ]; # 0..1 Benefit classification
        fhir:Claim.item.detail.subDetail.productOrService [ CodeableConcept ]; # 1..1 Billing, service, product, or drug code
        fhir:Claim.item.detail.subDetail.modifier [ CodeableConcept ], ... ; # 0..* Модификаторы выставления счёта за услугу/продукт
        fhir:Claim.item.detail.subDetail.programCode [ CodeableConcept ], ... ; # 0..* Program the product or service is provided under
        fhir:Claim.item.detail.subDetail.quantity [ Quantity(SimpleQuantity) ]; # 0..1 Количество продуктов или услуг
        fhir:Claim.item.detail.subDetail.unitPrice [ Money ]; # 0..1 Fee, charge or cost per item
        fhir:Claim.item.detail.subDetail.factor [ decimal ]; # 0..1 Коэффициент масштабирования цены
        fhir:Claim.item.detail.subDetail.net [ Money ]; # 0..1 Общая стоимость позиции
        fhir:Claim.item.detail.subDetail.udi [ Reference(Device) ], ... ; # 0..* Уникальный идентификатор устройства (UDI)
      ], ...;
    ], ...;
  ], ...;
  fhir:Claim.total [ Money ]; # 0..1 Общая стоимость требования о страховом возмещении
]

Changes since Release 3

Claim
Claim.status
  • Min Cardinality changed from 0 to 1
Claim.type
  • Min Cardinality changed from 0 to 1
  • Change binding strength from required to extensible
Claim.subType
  • Max Cardinality changed from * to 1
Claim.use
  • Min Cardinality changed from 0 to 1
  • Remove Codes complete, proposed, exploratory, other
  • Add Codes claim, preauthorization, predetermination
Claim.patient
  • Min Cardinality changed from 0 to 1
Claim.created
  • Min Cardinality changed from 0 to 1
Claim.enterer
  • Type Reference: Added Target Type PractitionerRole
Claim.provider
  • Min Cardinality changed from 0 to 1
  • Type Reference: Added Target Types PractitionerRole, Organization
Claim.priority
  • Min Cardinality changed from 0 to 1
Claim.prescription
  • Type Reference: Added Target Type DeviceRequest
Claim.originalPrescription
  • Type Reference: Added Target Types DeviceRequest, VisionPrescription
Claim.payee.party
  • Type Reference: Added Target Type PractitionerRole
Claim.referral
  • Type Reference: Added Target Type ServiceRequest
  • Type Reference: Removed Target Type ReferralRequest
Claim.careTeam.provider
  • Type Reference: Added Target Type PractitionerRole
Claim.supportingInfo
  • Added Element
Claim.supportingInfo.sequence
  • Added Mandatory Element
Claim.supportingInfo.category
  • Added Mandatory Element
Claim.supportingInfo.code
  • Added Element
Claim.supportingInfo.timing[x]
  • Added Element
Claim.supportingInfo.value[x]
  • Added Element
Claim.supportingInfo.reason
  • Added Element
Claim.diagnosis.onAdmission
  • Added Element
Claim.procedure.type
  • Added Element
Claim.procedure.udi
  • Added Element
Claim.insurance
  • Min Cardinality changed from 0 to 1
Claim.insurance.identifier
  • Added Element
Claim.accident.type
  • Change binding strength from required to extensible
Claim.item.careTeamSequence
  • Added Element
Claim.item.diagnosisSequence
  • Added Element
Claim.item.procedureSequence
  • Added Element
Claim.item.informationSequence
  • Added Element
Claim.item.productOrService
  • Added Mandatory Element
Claim.item.detail.productOrService
  • Added Mandatory Element
Claim.item.detail.subDetail.productOrService
  • Added Mandatory Element
Claim.organization
  • deleted
Claim.payee.resourceType
  • deleted
Claim.information
  • deleted
Claim.employmentImpacted
  • deleted
Claim.hospitalization
  • deleted
Claim.item.careTeamLinkId
  • deleted
Claim.item.diagnosisLinkId
  • deleted
Claim.item.procedureLinkId
  • deleted
Claim.item.informationLinkId
  • deleted
Claim.item.service
  • deleted
Claim.item.detail.service
  • deleted
Claim.item.detail.subDetail.service
  • deleted

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 3 fail to execute. 13 fail round-trip testing and 1 r3 resources are invalid (0 errors).)

 

See the Profiles & Extensions and the Альтернативные определения: Основное определение XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the Анализ зависимостей

PathОписаниеТипСсылка
Claim.status A code specifying the state of the resource instance.RequiredFinancialResourceStatusCodes
Claim.type Тип или специализация требования о страховом возмещении.ExtensibleClaimTypeCodes
Claim.subType A more granular claim typecode.ExampleExampleClaimSubTypeCodes
Claim.use The purpose of the Claim: predetermination, preauthorization, claim.RequiredUse
Claim.priority Приоритет обработки: безотлагательный, обычный, отложенный.ExampleProcessPriorityCodes
Claim.fundsReserve For whom funds are to be reserved: (Patient, Provider, None).ExampleFunds Reservation Codes
Claim.related.relationship Взаимосвязь между этим требованием о страховом возмещении и связанным требованием о страховом возмещении.ExampleExampleRelatedClaimRelationshipCodes
Claim.payee.type A code for the party to be reimbursed.ExampleClaim Payee Type Codes
Claim.careTeam.role The role codes for the care team members.ExampleClaimCareTeamRoleCodes
Claim.careTeam.qualification Provider professional qualifications.ExampleExampleProviderQualificationCodes
Claim.supportingInfo.category The valuset used for additional information category codes.ExampleClaimInformationCategoryCodes
Claim.supportingInfo.code The valuset used for additional information codes.ExampleExceptionCodes
Claim.supportingInfo.reason Коды причин отсутствия зубов.ExampleMissingToothReasonCodes
Claim.diagnosis.diagnosis[x] Example Диагностические коды ICD10.ExampleICD-10Codes
Claim.diagnosis.type The type of the diagnosis: admitting, principal, discharge.ExampleExampleDiagnosisTypeCodes
Claim.diagnosis.onAdmission Present on admission.ExampleExampleDiagnosisOnAdmissionCodes
Claim.diagnosis.packageCode The DRG codes associated with the diagnosis.ExampleExampleDiagnosisRelatedGroupCodes
Claim.procedure.type Example procedure type codes.ExampleExampleProcedureTypeCodes
Claim.procedure.procedure[x] Example ICD10 Procedure codes.ExampleICD-10ProcedureCodes
Claim.accident.type Тип несчастного случая: производственный, автомобильная авария и т. д.Extensiblev3.ActIncidentCode
Claim.item.revenue
Claim.item.detail.revenue
Claim.item.detail.subDetail.revenue
Codes for the revenue or cost centers supplying the service and/or products.ExampleExampleRevenueCenterCodes
Claim.item.category
Claim.item.detail.category
Claim.item.detail.subDetail.category
Benefit categories such as: oral-basic, major, glasses.ExampleBenefitCategoryCodes
Claim.item.productOrService
Claim.item.detail.productOrService
Claim.item.detail.subDetail.productOrService
Допустимые коды услуг и продуктов.ExampleUSCLSCodes
Claim.item.modifier
Claim.item.detail.modifier
Claim.item.detail.subDetail.modifier
Коды типов пунктов или модификаторов, например для стоматологии, было ли лечение косметическим или связано с TMJ, или было ли утеряно или украдено приспособление.ExampleModifierTypeCodes
Claim.item.programCode
Claim.item.detail.programCode
Claim.item.detail.subDetail.programCode
Коды обоснований, специфичные для программ.ExampleExampleProgramReasonCodes
Claim.item.location[x] Place of service: pharmacy, school, prison, etc.ExampleExampleServicePlaceCodes
Claim.item.bodySite Код зуба, квадрант, секстант и арка.ExampleOralSiteCodes
Claim.item.subSite Код поверхности зуба и комбинаций поверхностей.ExampleSurfaceCodes

Параметры поиска для этого ресурса. Также к нему применяются общие параметры. Более подробную информацию о поиске в REST, обмене сообщениями и сервисах см. в разделе Поиск.

ИмяТипОпределениеВыражениеIn Common
care-teamreferenceMember of the CareTeamClaim.careTeam.provider
(Practitioner, Organization, PractitionerRole)
createddateДата создания требования о страховом возмещенииClaim.created
detail-udireferenceUDI associated with a line item detail product or serviceClaim.item.detail.udi
(Device)
encounterreferenceEncounters associated with a billed line itemClaim.item.encounter
(Encounter)
entererreferenceThe party responsible for the entry of the ClaimClaim.enterer
(Practitioner, PractitionerRole)
facilityreferenceFacility where the products or services were/are to be providedClaim.facility
(Location)
identifiertokenОсновной идентификатор финансового ресурсаClaim.identifier
insurerreferenceЦелевой плательщик/страховая компания требования о страховом возмещенииClaim.insurer
(Organization)
item-udireferenceUDI associated with a line item product or serviceClaim.item.udi
(Device)
patientreferencePatient receiving the products or servicesClaim.patient
(Patient)
payeereferenceThe party receiving any payment for the ClaimClaim.payee.party
(Practitioner, Organization, Patient, PractitionerRole, RelatedPerson)
prioritytokenЗапрашиваемый приоритет обработкиClaim.priority
procedure-udireferenceUDI associated with a procedureClaim.procedure.udi
(Device)
providerreferenceПоставщик, ответственный за это требование о страховом возмещенииClaim.provider
(Practitioner, Organization, PractitionerRole)
statustokenThe status of the Claim instance.Claim.status
subdetail-udireferenceUDI associated with a line item detail subdetail product or serviceClaim.item.detail.subDetail.udi
(Device)
usetokenТип финансового ресурсаClaim.use