Intersection of https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaim and https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaim

This is the set of resources that conform to both MyCareNet eAgreement Claim BE profile (https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaim) and MyCareNet eAgreement Claim BE profile (https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaim).

Structure

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Claim C0..*Claim, Pre-determination or Pre-authorization
Constraints: be-rule-eagreementclaim-1, be-rule-eagreementclaim-2, be-rule-eagreementclaim-3
Claim.meta This element must be supported. This element is included in summaries. 1..1MetaMetadata about the resource
Claim.meta.extension 0..*ExtensionAdditional content defined by implementations
Claim.meta.versionId This element is included in summaries. 0..1idVersion specific identifier
Claim.meta.lastUpdated This element is included in summaries. 0..1instantWhen the resource version last changed
Claim.meta.source This element is included in summaries. 0..1uriIdentifies where the resource comes from
Claim.meta.profile This element is included in summaries. 1..1canonical(StructureDefinition)Profiles this resource claims to conform to
Claim.meta.security This element is included in summaries. 0..*CodingSecurity Labels applied to this resource
Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Claim.meta.tag This element is included in summaries. 0..*CodingTags applied to this resource
Binding: ?? (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
Claim.implicitRules This element is a modifier element. This element is included in summaries. 0..1uriA set of rules under which this content was created
Claim.language 0..1codeLanguage of the resource content
Binding: ?? (preferred): A human language.
Additional BindingsPurpose
??Max Binding
Claim.text 0..1NarrativeText summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Claim.contained 0..*ResourceContained, inline Resources
Claim.extension 0..*ExtensionAdditional content defined by implementations
Claim.modifierExtension This element is a modifier element. 0..*ExtensionExtensions that cannot be ignored
Claim.identifier 0..*IdentifierBusiness Identifier for claim
Claim.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1codeactive | cancelled | draft | entered-in-error
Binding: ?? (required): A code specifying the state of the resource instance.
Claim.type This element must be supported. This element is included in summaries. 1..1CodeableConceptCategory or discipline
Binding: ?? (extensible): The type or discipline-style of the claim.
Claim.type.extension 0..*ExtensionAdditional content defined by implementations
Claim.type.coding This element is included in summaries. 1..1CodingCode defined by a terminology system
Claim.type.coding.extension 0..*ExtensionAdditional content defined by implementations
Claim.type.coding.system This element is included in summaries. 1..1uriIdentity of the terminology system
Claim.type.coding.version This element is included in summaries. 0..1stringVersion of the system - if relevant
Claim.type.coding.code This element is included in summaries. 1..1codeSymbol in syntax defined by the system
Claim.type.coding.display This element is included in summaries. 0..1stringRepresentation defined by the system
Claim.type.coding.userSelected This element is included in summaries. 0..1booleanIf this coding was chosen directly by the user
Claim.type.text This element is included in summaries. 0..1stringPlain text representation of the concept
Claim.subType This element must be supported. 1..1CodeableConceptMore granular claim type
Binding: ?? (example): A more granular claim typecode.
Claim.subType.extension 0..*ExtensionAdditional content defined by implementations
Claim.subType.coding This element is included in summaries. 1..1CodingCode defined by a terminology system
Claim.subType.coding.extension 0..*ExtensionAdditional content defined by implementations
Claim.subType.coding.system This element is included in summaries. 1..1uriIdentity of the terminology system
Claim.subType.coding.version This element is included in summaries. 0..1stringVersion of the system - if relevant
Claim.subType.coding.code This element is included in summaries. 1..1codeSymbol in syntax defined by the system
Claim.subType.coding.display This element is included in summaries. 0..1stringRepresentation defined by the system
Claim.subType.coding.userSelected This element is included in summaries. 0..1booleanIf this coding was chosen directly by the user
Claim.subType.text This element is included in summaries. 0..1stringPlain text representation of the concept
Claim.use This element must be supported. This element is included in summaries. 1..1codeclaim | preauthorization | predetermination
Binding: ?? (required): The purpose of the Claim: predetermination, preauthorization, claim.
Claim.patient This element must be supported. This element is included in summaries. 1..1Reference(BePatient)The recipient of the products and services
Claim.billablePeriod This element must be supported. This element is included in summaries. 0..1PeriodRelevant time frame for the claim
Claim.created This element must be supported. This element is included in summaries. 1..1dateTimeResource creation date
Claim.enterer This element must be supported. 0..1Reference(BePractitionerRole)Author of the claim
Claim.enterer.extension 0..*ExtensionAdditional content defined by implementations
Claim.enterer.reference This element is included in summaries. 1..1stringLiteral reference, Relative, internal or absolute URL
Claim.enterer.type This element is included in summaries. 0..1uriType the reference refers to (e.g. "Patient")
Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
Claim.enterer.identifier This element is included in summaries. 0..1IdentifierLogical reference, when literal reference is not known
Claim.enterer.display This element is included in summaries. 0..1stringText alternative for the resource
Claim.insurer This element is included in summaries. 0..1Reference(Organization)Target
Claim.provider This element must be supported. This element is included in summaries. 1..1Reference(BeOrganization | BePractitionerRole)Party responsible for the claim
Claim.provider.extension 0..*ExtensionAdditional content defined by implementations
Claim.provider.reference This element is included in summaries. 1..1stringLiteral reference, Relative, internal or absolute URL
Claim.provider.type This element is included in summaries. 0..1uriType the reference refers to (e.g. "Patient")
Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
Claim.provider.identifier This element is included in summaries. 0..1IdentifierLogical reference, when literal reference is not known
Claim.provider.display This element is included in summaries. 0..1stringText alternative for the resource
Claim.priority This element must be supported. This element is included in summaries. 1..1CodeableConceptDesired processing ugency
Binding: ?? (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.priority.extension 0..*ExtensionAdditional content defined by implementations
Claim.priority.coding This element is included in summaries. 1..1CodingCode defined by a terminology system
Claim.priority.coding.extension 0..*ExtensionAdditional content defined by implementations
Claim.priority.coding.system This element is included in summaries. 1..1uriIdentity of the terminology system
Claim.priority.coding.version This element is included in summaries. 0..1stringVersion of the system - if relevant
Claim.priority.coding.code This element is included in summaries. 1..1codeSymbol in syntax defined by the system
Claim.priority.coding.display This element is included in summaries. 0..1stringRepresentation defined by the system
Claim.priority.coding.userSelected This element is included in summaries. 0..1booleanIf this coding was chosen directly by the user
Claim.priority.text This element is included in summaries. 0..1stringPlain text representation of the concept
Claim.fundsReserve 0..1CodeableConceptFor whom to reserve funds
Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
Claim.related 0..*BackboneElementPrior or corollary claims
Claim.related.extension 0..*ExtensionAdditional content defined by implementations
Claim.related.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
Claim.related.claim 0..1Reference(Claim)Reference to the related claim
Claim.related.relationship 0..1CodeableConceptHow the reference claim is related
Binding: ?? (example): Relationship of this claim to a related Claim.
Claim.related.reference 0..1IdentifierFile or case reference
Claim.prescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Prescription authorizing services and products
Claim.originalPrescription 0..1Reference(DeviceRequest | MedicationRequest | VisionPrescription)Original prescription if superseded by fulfiller
Claim.payee 0..1BackboneElementRecipient of benefits payable
Claim.payee.extension 0..*ExtensionAdditional content defined by implementations
Claim.payee.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
Claim.payee.type 1..1CodeableConceptCategory of recipient
Binding: ?? (example): A code for the party to be reimbursed.
Claim.payee.party 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)Recipient reference
Claim.referral This element must be supported. 0..1Reference(ServiceRequest)Treatment referral
Claim.referral.extension 0..*ExtensionAdditional content defined by implementations
Claim.referral.reference This element is included in summaries. 1..1stringLiteral reference, Relative, internal or absolute URL
Claim.referral.type This element is included in summaries. 0..1uriType the reference refers to (e.g. "Patient")
Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
Claim.referral.identifier This element is included in summaries. 0..1IdentifierLogical reference, when literal reference is not known
Claim.referral.display This element is included in summaries. 0..1stringText alternative for the resource
Claim.facility 0..1Reference(Location)Servicing facility
Claim.careTeam 0..*BackboneElementMembers of the care team
Claim.careTeam.extension 0..*ExtensionAdditional content defined by implementations
Claim.careTeam.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
Claim.careTeam.sequence 1..1positiveIntOrder of care team
Claim.careTeam.provider 1..1Reference(Practitioner | PractitionerRole | Organization)Practitioner or organization
Claim.careTeam.responsible 0..1booleanIndicator of the lead practitioner
Claim.careTeam.role 0..1CodeableConceptFunction within the team
Binding: ?? (example): The role codes for the care team members.
Claim.careTeam.qualification 0..1CodeableConceptPractitioner credential or specialization
Binding: ?? (example): Provider professional qualifications.
Claim.supportingInfo This element must be supported. 0..*BackboneElementSupporting information
Claim.supportingInfo.extension 0..*ExtensionAdditional content defined by implementations
Claim.supportingInfo.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
Claim.supportingInfo.sequence 1..1positiveIntInformation instance identifier
Claim.supportingInfo.category This element must be supported. 1..1CodeableConceptClassification of the supplied information
Binding: ?? (example): The valuset used for additional information category codes.
Claim.supportingInfo.category.extension 0..*ExtensionAdditional content defined by implementations
Claim.supportingInfo.category.coding This element is included in summaries. 1..1CodingCode defined by a terminology system
Claim.supportingInfo.category.coding.extension 0..*ExtensionAdditional content defined by implementations
Claim.supportingInfo.category.coding.system This element is included in summaries. 1..1uriIdentity of the terminology system
Claim.supportingInfo.category.coding.version This element is included in summaries. 0..1stringVersion of the system - if relevant
Claim.supportingInfo.category.coding.code This element is included in summaries. 1..1codeSymbol in syntax defined by the system
Claim.supportingInfo.category.coding.display This element is included in summaries. 0..1stringRepresentation defined by the system
Claim.supportingInfo.category.coding.userSelected This element is included in summaries. 0..1booleanIf this coding was chosen directly by the user
Claim.supportingInfo.category.text This element is included in summaries. 0..1stringPlain text representation of the concept
Claim.supportingInfo.code 0..1CodeableConceptType of information
Binding: ?? (example): The valuset used for additional information codes.
Claim.supportingInfo.code.extension 0..*ExtensionAdditional content defined by implementations
Claim.supportingInfo.code.coding This element is included in summaries. 1..1CodingCode defined by a terminology system
Claim.supportingInfo.code.coding.extension 0..*ExtensionAdditional content defined by implementations
Claim.supportingInfo.code.coding.system This element is included in summaries. 1..1uriIdentity of the terminology system
Claim.supportingInfo.code.coding.version This element is included in summaries. 0..1stringVersion of the system - if relevant
Claim.supportingInfo.code.coding.code This element is included in summaries. 1..1codeSymbol in syntax defined by the system
Claim.supportingInfo.code.coding.display This element is included in summaries. 0..1stringRepresentation defined by the system
Claim.supportingInfo.code.coding.userSelected This element is included in summaries. 0..1booleanIf this coding was chosen directly by the user
Claim.supportingInfo.code.text This element is included in summaries. 0..1stringPlain text representation of the concept
Claim.supportingInfo.timing[x] 0..1When it occurred
Claim.supportingInfo.timing[x].timingDatedate
Claim.supportingInfo.timing[x].timingPeriodPeriod
Claim.supportingInfo.value[x] 0..1Data to be provided
Claim.supportingInfo.value[x].valueBooleanboolean
Claim.supportingInfo.value[x].valueStringstring
Claim.supportingInfo.value[x].valueQuantityQuantity
Claim.supportingInfo.value[x].valueAttachmentAttachment
Claim.supportingInfo.value[x].valueReferenceReference(Resource)
Claim.supportingInfo.reason 0..1CodeableConceptExplanation for the information
Binding: ?? (example): Reason codes for the missing teeth.
Claim.diagnosis 0..*BackboneElementPertinent diagnosis information
Claim.diagnosis.extension 0..*ExtensionAdditional content defined by implementations
Claim.diagnosis.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
Claim.diagnosis.sequence 1..1positiveIntDiagnosis instance identifier
Claim.diagnosis.diagnosis[x] 1..1Nature of illness or problem
Binding: ?? (example): Example ICD10 Diagnostic codes.
Claim.diagnosis.diagnosis[x].diagnosisCodeableConceptCodeableConcept
Claim.diagnosis.diagnosis[x].diagnosisReferenceReference(Condition)
Claim.diagnosis.type 0..*CodeableConceptTiming or nature of the diagnosis
Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge.
Claim.diagnosis.onAdmission 0..1CodeableConceptPresent on admission
Binding: ?? (example): Present on admission.
Claim.diagnosis.packageCode 0..1CodeableConceptPackage billing code
Binding: ?? (example): The DRG codes associated with the diagnosis.
Claim.procedure 0..*BackboneElementClinical procedures performed
Claim.procedure.extension 0..*ExtensionAdditional content defined by implementations
Claim.procedure.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
Claim.procedure.sequence 1..1positiveIntProcedure instance identifier
Claim.procedure.type 0..*CodeableConceptCategory of Procedure
Binding: ?? (example): Example procedure type codes.
Claim.procedure.date 0..1dateTimeWhen the procedure was performed
Claim.procedure.procedure[x] 1..1Specific clinical procedure
Binding: ?? (example): Example ICD10 Procedure codes.
Claim.procedure.procedure[x].procedureCodeableConceptCodeableConcept
Claim.procedure.procedure[x].procedureReferenceReference(Procedure)
Claim.procedure.udi 0..*Reference(Device)Unique device identifier
Claim.insurance This element must be supported. This element is included in summaries. 1..1BackboneElementPatient insurance information
Claim.insurance.extension 0..*ExtensionAdditional content defined by implementations
Claim.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
Claim.insurance.sequence This element is included in summaries. 1..1positiveIntInsurance instance identifier
Claim.insurance.focal This element is included in summaries. 1..1booleanCoverage to be used for adjudication
Claim.insurance.identifier 0..1IdentifierPre-assigned Claim number
Claim.insurance.coverage This element is included in summaries. 1..1Reference(Coverage)Insurance information
Claim.insurance.coverage.extension 0..*ExtensionAdditional content defined by implementations
Claim.insurance.coverage.reference This element is included in summaries. 0..1stringLiteral reference, Relative, internal or absolute URL
Claim.insurance.coverage.type This element is included in summaries. 0..1uriType the reference refers to (e.g. "Patient")
Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
Claim.insurance.coverage.identifier This element is included in summaries. 0..1IdentifierLogical reference, when literal reference is not known
Claim.insurance.coverage.display This element is included in summaries. 1..1stringText alternative for the resource
Claim.insurance.businessArrangement 0..1stringAdditional provider contract number
Claim.insurance.preAuthRef 0..*stringPrior authorization reference number
Claim.insurance.claimResponse 0..1Reference(ClaimResponse)Adjudication results
Claim.accident 0..1BackboneElementDetails of the event
Claim.accident.extension 0..*ExtensionAdditional content defined by implementations
Claim.accident.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
Claim.accident.date 1..1dateWhen the incident occurred
Claim.accident.type 0..1CodeableConceptThe nature of the accident
Binding: ?? (extensible): Type of accident: work place, auto, etc.
Claim.accident.location[x] 0..1Where the event occurred
Claim.accident.location[x].locationAddressAddress
Claim.accident.location[x].locationReferenceReference(Location)
Claim.item This element must be supported. 0..*BackboneElementProduct or service provided
Claim.item.extension 0..*ExtensionAdditional content defined by implementations
Claim.item.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
Claim.item.sequence 1..1positiveIntItem instance identifier
Claim.item.careTeamSequence 0..*positiveIntApplicable careTeam members
Claim.item.diagnosisSequence 0..*positiveIntApplicable diagnoses
Claim.item.procedureSequence 0..*positiveIntApplicable procedures
Claim.item.informationSequence 0..*positiveIntApplicable exception and supporting information
Claim.item.revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
Claim.item.productOrService.extension 0..*ExtensionAdditional content defined by implementations
Claim.item.productOrService.coding This element is included in summaries. 1..1CodingCode defined by a terminology system
Binding: ?? (extensible)
Claim.item.productOrService.coding.extension 0..*ExtensionAdditional content defined by implementations
Claim.item.productOrService.coding.system This element is included in summaries. 1..1uriIdentity of the terminology system
Claim.item.productOrService.coding.version This element is included in summaries. 0..1stringVersion of the system - if relevant
Claim.item.productOrService.coding.code This element is included in summaries. 1..1codeSymbol in syntax defined by the system
Claim.item.productOrService.coding.display This element is included in summaries. 0..1stringRepresentation defined by the system
Claim.item.productOrService.coding.userSelected This element is included in summaries. 0..1booleanIf this coding was chosen directly by the user
Claim.item.productOrService.text This element is included in summaries. 0..1stringPlain text representation of the concept
Claim.item.modifier 0..*CodeableConceptProduct or service billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
Claim.item.serviced[x] 0..1dateDate or dates of service or product delivery
Claim.item.location[x] 0..1Place of service or where product was supplied
Binding: ?? (example): Place of service: pharmacy, school, prison, etc.
Claim.item.location[x].locationCodeableConceptCodeableConcept
Claim.item.location[x].locationAddressAddress
Claim.item.location[x].locationReferenceReference(Location)
Claim.item.quantity 0..1?? The snapshot does not say whether the constraints on the root of this type profile have been applied to this element, so assume they have not. Check the type profile directly as well, ?? The snapshot does not say whether the constraints on the root of this type profile have been applied to this element, so assume they have not. Check the type profile directly as wellCount of products or services
Claim.item.unitPrice 0..1MoneyFee, charge or cost per item
Claim.item.factor 0..1decimalPrice scaling factor
Claim.item.net 0..1MoneyTotal item cost
Claim.item.udi 0..*Reference(Device)Unique device identifier
Claim.item.bodySite 0..1CodeableConceptAnatomical location
Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.
Claim.item.subSite 0..*CodeableConceptAnatomical sub-location
Binding: ?? (example): The code for the tooth surface and surface combinations.
Claim.item.encounter 0..*Reference(Encounter)Encounters related to this billed item
Claim.item.detail 0..*BackboneElementProduct or service provided
Claim.item.detail.extension 0..*ExtensionAdditional content defined by implementations
Claim.item.detail.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
Claim.item.detail.sequence 1..1positiveIntItem instance identifier
Claim.item.detail.revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.detail.category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
Claim.item.detail.modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.detail.programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
Claim.item.detail.quantity 0..1?? The snapshot does not say whether the constraints on the root of this type profile have been applied to this element, so assume they have not. Check the type profile directly as well, ?? The snapshot does not say whether the constraints on the root of this type profile have been applied to this element, so assume they have not. Check the type profile directly as wellCount of products or services
Claim.item.detail.unitPrice 0..1MoneyFee, charge or cost per item
Claim.item.detail.factor 0..1decimalPrice scaling factor
Claim.item.detail.net 0..1MoneyTotal item cost
Claim.item.detail.udi 0..*Reference(Device)Unique device identifier
Claim.item.detail.subDetail 0..*BackboneElementProduct or service provided
Claim.item.detail.subDetail.extension 0..*ExtensionAdditional content defined by implementations
Claim.item.detail.subDetail.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
Claim.item.detail.subDetail.sequence 1..1positiveIntItem instance identifier
Claim.item.detail.subDetail.revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.detail.subDetail.category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.subDetail.productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
Claim.item.detail.subDetail.modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.detail.subDetail.programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
Claim.item.detail.subDetail.quantity 0..1?? The snapshot does not say whether the constraints on the root of this type profile have been applied to this element, so assume they have not. Check the type profile directly as well, ?? The snapshot does not say whether the constraints on the root of this type profile have been applied to this element, so assume they have not. Check the type profile directly as wellCount of products or services
Claim.item.detail.subDetail.unitPrice 0..1MoneyFee, charge or cost per item
Claim.item.detail.subDetail.factor 0..1decimalPrice scaling factor
Claim.item.detail.subDetail.net 0..1MoneyTotal item cost
Claim.item.detail.subDetail.udi 0..*Reference(Device)Unique device identifier
Claim.total 0..1MoneyTotal claim cost

doco Documentation for this format