MyCareNet eAgreement Claim Logo BE profile - Belgian MyCareNet Profiles v2.2.1

This page is part of the HL7 Belgium FHIR Implementation Guide - Mycarenet profiles (v2.2.1: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: MyCareNet eAgreement Claim Logo BE profile

Official URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaim-logo	Version: 2.2.1	Highlight text changes?
Standards status: Trial-use	Maturity Level: 1	Computable Name: MyBeMyCareNetEagreementClaimLogo
Other Identifiers: OID:2.16.840.1.113883.4.642.40.200.6.42.2

Claim profile for use in the different eAgreement flow from MyCareNet for speech therapy. This profile is a diff on the general be-eagreementclaim.

Usages:

This Profile is not used by any profiles in this Specification

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

Key Elements Table
Differential Table
Snapshot Table
Statistics/References
All

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Claim	C	0..*	BeMyCareNetEagreementClaim	Claim, Pre-determination or Pre-authorization Constraints: be-rule-eagreementclaim-1, be-rule-eagreementclaim-2, be-rule-eagreementclaim-3
Claim.id	This element must be supported. This element is included in summaries.	1..1	id	Logical id of this artifact
Claim.meta	This element must be supported. This element is included in summaries.	1..1	Meta	Metadata about the resource
Claim.meta.profile	This element is included in summaries.	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Claim.implicitRules	This element is a modifier element. This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Claim.modifierExtension	This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.status	This element is a modifier element. This element must be supported. This element is included in summaries.	1..1	code	active \| cancelled \| draft \| entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active (no extensions allowed)
Claim.type	This element must be supported. This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Claim.type.coding	This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.type.coding.system	This element is included in summaries.	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type (no extensions allowed)
Claim.type.coding.code	This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.subType	This element must be supported.	1..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
Claim.subType.coding	This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.subType.coding.system	This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types (extensions allowed)
Claim.subType.coding.code	This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.use	This element must be supported. This element is included in summaries.	1..1	code	claim \| preauthorization \| predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Fixed Value: preauthorization (no extensions allowed)
Claim.patient	This element must be supported. This element is included in summaries.	1..1	Reference(BePatient)	The recipient of the products and services
Claim.billablePeriod	This element must be supported. This element is included in summaries.	0..1	Period	Relevant time frame for the claim
Claim.created	This element must be supported. This element is included in summaries.	1..1	dateTime	Resource creation date
Claim.enterer	This element must be supported.	0..1	Reference(BePractitionerRole)	Author of the claim
Claim.enterer.reference	This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Claim.provider	This element must be supported. This element is included in summaries.	1..1	Reference(BeOrganization \| BePractitionerRole)	Party responsible for the claim
Claim.provider.reference	This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Claim.priority	This element must be supported. This element is included in summaries.	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.priority.coding	This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.priority.coding.system	This element is included in summaries.	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority (no extensions allowed)
Claim.priority.coding.code	This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.referral	This element must be supported.	0..1	Reference(ServiceRequest)	Treatment referral
Claim.referral.reference	This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Claim.supportingInfo	This element must be supported.	0..*	BackboneElement	Supporting information
Claim.supportingInfo.modifierExtension	This element is a modifier element. This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.supportingInfo.sequence		1..1	positiveInt	Information instance identifier
Claim.supportingInfo.category	This element must be supported.	1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.supportingInfo.category.coding	This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.supportingInfo.category.coding.system	This element is included in summaries.	1..1	uri	Identity of the terminology system
Claim.supportingInfo.category.coding.code	This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.procedure		0..*	BackboneElement	Clinical procedures performed
Claim.procedure.modifierExtension	This element is a modifier element. This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.procedure.sequence		1..1	positiveInt	Procedure instance identifier
Claim.procedure.date	This element must be supported.	1..1	dateTime	When the procedure was performed
Claim.procedure.Slices for procedure[x]		1..1		Specific clinical procedure Slice: Unordered, Closed by type:$this Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them Other type slices that contain no new information are not shown in this view
Claim.procedure.Slices for procedure[x].procedureCodeableConcept			CodeableConcept
Claim.procedure.Slices for procedure[x].procedureReference			Reference(Procedure)
Claim.procedure.Slices for procedure[x].procedure[x]:procedureCodeableConcept		0..1	CodeableConcept	Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes. Required Pattern: `{ "coding" : [ { "system" : "http://snomed.info/sct", "code" : "386053000" } ] }`
Claim.insurance	This element must be supported. This element is included in summaries.	1..1	BackboneElement	Patient insurance information
Claim.insurance.modifierExtension	This element is a modifier element. This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence	This element is included in summaries.	1..1	positiveInt	Insurance instance identifier Fixed Value: 1 (no extensions allowed)
Claim.insurance.focal	This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication Fixed Value: true (no extensions allowed)
Claim.insurance.coverage	This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Claim.insurance.coverage.display	This element is included in summaries.	1..1	string	Text alternative for the resource
Claim.item	This element must be supported.	0..*	BackboneElement	Product or service provided
Claim.item.modifierExtension	This element is a modifier element. This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.sequence		1..1	positiveInt	Item instance identifier
Claim.item.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.productOrService.coding	This element is included in summaries.	1..1	Coding	Code defined by a terminology system Binding: Speech Therapy Pathology Situation Code (required)
Claim.item.productOrService.coding.system	This element is included in summaries.	1..1	uri	Identity of the terminology system
Claim.item.productOrService.coding.code	This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
Claim.subType	Base	example	Example Claim SubType Codes	📍4.0.1	FHIR Std.
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.priority	Base	example	Process Priority Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]:procedureCodeableConcept	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.productOrService.coding	Base	required	Speech Therapy Pathology Situation Code	📦1.1.0	HL7 Belgium NIHDI Terminology v1.1

Constraints

Id	Grade	Path(s)	Description	Expression
be-rule-eagreementclaim-1	error	Claim	Billable period start and end SHALL be YYYY-MM-DD	`(Claim.billablePeriod.start.exists() implies Claim.billablePeriod.start.toString().length()=10) and (Claim.billablePeriod.end.exists() implies Claim.billablePeriod.end.toString().length()=10)`
be-rule-eagreementclaim-2	error	Claim	Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz	`Claim.created.toString().length()=25`
be-rule-eagreementclaim-3	error	Claim	Procedure.date SHALL be YYYY-MM-DD	`Claim.procedure.date.exists() implies Claim.procedure.date.select(toString().length()=10).allTrue()`
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	`contained.contained.empty()`
dom-3	error	Claim	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	`contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	`contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	`contained.meta.security.empty()`
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children	`hasValue() or (children().count() > id.count())`
ext-1	error	ALL extensions	Must have either extensions or value[x], not both	`extension.exists() != value.exists()`

This structure is derived from BeMyCareNetEagreementClaim

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Claim		0..*	BeMyCareNetEagreementClaim	Claim, Pre-determination or Pre-authorization
Claim.procedure
Claim.procedure.date	This element must be supported.	1..1	dateTime	When the procedure was performed
Claim.procedure.Slices for procedure[x]		1..1	CodeableConcept, Reference(Procedure)	Specific clinical procedure Slice: Unordered, Open by type:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them Other type slices that contain no new information are not shown in this view
Claim.procedure.Slices for procedure[x].procedure[x]:procedureCodeableConcept		0..1	CodeableConcept	Specific clinical procedure Required Pattern: `{ "coding" : [ { "system" : "http://snomed.info/sct", "code" : "386053000" } ] }`
Claim.item
Claim.item.productOrService
Claim.item.productOrService.coding		1..1	Coding	Code defined by a terminology system Binding: Speech Therapy Pathology Situation Code (required)
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Claim.item.productOrService.coding	Base	required	Speech Therapy Pathology Situation Code	📦1.1.0	HL7 Belgium NIHDI Terminology v1.1

Description & Constraints Filter:

Claim C 0..* BeMyCareNetEagreementClaim Claim, Pre-determination or Pre-authorization
Constraints: be-rule-eagreementclaim-1, be-rule-eagreementclaim-2, be-rule-eagreementclaim-3

Claim.id This element must be supported. This element is included in summaries. 1..1 id Logical id of this artifact

Claim.meta This element must be supported. This element is included in summaries. 1..1 Meta Metadata about the resource

Claim.meta.id 0..1 string Unique id for inter-element referencing

Claim.meta.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

Claim.meta.versionId This element is included in summaries. 0..1 id Version specific identifier

Claim.meta.lastUpdated This element is included in summaries. 0..1 instant When the resource version last changed

Claim.meta.source This element is included in summaries. 0..1 uri Identifies where the resource comes from

Claim.meta.profile This element is included in summaries. 1..1 canonical(StructureDefinition) Profiles this resource claims to conform to

Claim.meta.security This element is included in summaries. 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.

Claim.meta.tag This element is included in summaries. 0..* Coding Tags applied to this resource
Binding: CommonTags (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..1 uri A set of rules under which this content was created

language

0..1

code

Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional Bindings

Purpose

AllLanguages

Max Binding

Claim.text 0..1 Narrative Text 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..* Resource Contained, inline Resources

Claim.extension 0..* Extension Additional content defined by implementations

Claim.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored

Claim.identifier 0..* Identifier Business Identifier for claim

Claim.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Fixed Value: active (no extensions allowed)

Claim.type This element must be supported. This element is included in summaries. 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.

Claim.type.id 0..1 string Unique id for inter-element referencing

Claim.type.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

Claim.type.coding This element is included in summaries. 1..1 Coding Code defined by a terminology system

Claim.type.coding.id 0..1 string Unique id for inter-element referencing

Claim.type.coding.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

Claim.type.coding.system This element is included in summaries. 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type (no extensions allowed)

Claim.type.coding.version This element is included in summaries. 0..1 string Version of the system - if relevant

Claim.type.coding.code This element is included in summaries. 1..1 code Symbol in syntax defined by the system

Claim.type.coding.display This element is included in summaries. 0..1 string Representation defined by the system

Claim.type.coding.userSelected This element is included in summaries. 0..1 boolean If this coding was chosen directly by the user

Claim.type.text This element is included in summaries. 0..1 string Plain text representation of the concept

Claim.subType This element must be supported. 1..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

Claim.subType.id 0..1 string Unique id for inter-element referencing

Claim.subType.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

Claim.subType.coding This element is included in summaries. 1..1 Coding Code defined by a terminology system

Claim.subType.coding.id 0..1 string Unique id for inter-element referencing

Claim.subType.coding.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

Claim.subType.coding.system This element is included in summaries. 1..1 uri Identity of the terminology system
Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types (extensions allowed)

Claim.subType.coding.version This element is included in summaries. 0..1 string Version of the system - if relevant

Claim.subType.coding.code This element is included in summaries. 1..1 code Symbol in syntax defined by the system

Claim.subType.coding.display This element is included in summaries. 0..1 string Representation defined by the system

Claim.subType.coding.userSelected This element is included in summaries. 0..1 boolean If this coding was chosen directly by the user

Claim.subType.text This element is included in summaries. 0..1 string Plain text representation of the concept

Claim.use This element must be supported. This element is included in summaries. 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Fixed Value: preauthorization (no extensions allowed)

Claim.patient This element must be supported. This element is included in summaries. 1..1 Reference(BePatient) The recipient of the products and services

Claim.billablePeriod This element must be supported. This element is included in summaries. 0..1 Period Relevant time frame for the claim

Claim.created This element must be supported. This element is included in summaries. 1..1 dateTime Resource creation date

Claim.enterer This element must be supported. 0..1 Reference(BePractitionerRole) Author of the claim

Claim.enterer.id 0..1 string Unique id for inter-element referencing

Claim.enterer.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

Claim.enterer.reference This element is included in summaries. C 1..1 string Literal reference, Relative, internal or absolute URL

Claim.enterer.type This element is included in summaries. 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

Claim.enterer.identifier This element is included in summaries. 0..1 Identifier Logical reference, when literal reference is not known

Claim.enterer.display This element is included in summaries. 0..1 string Text alternative for the resource

Claim.insurer This element is included in summaries. 0..1 Reference(Organization) Target

Claim.provider This element must be supported. This element is included in summaries. 1..1 Reference(BeOrganization | BePractitionerRole) Party responsible for the claim

Claim.provider.id 0..1 string Unique id for inter-element referencing

Claim.provider.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

Claim.provider.reference This element is included in summaries. C 1..1 string Literal reference, Relative, internal or absolute URL

Claim.provider.type This element is included in summaries. 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

Claim.provider.identifier This element is included in summaries. 0..1 Identifier Logical reference, when literal reference is not known

Claim.provider.display This element is included in summaries. 0..1 string Text alternative for the resource

Claim.priority This element must be supported. This element is included in summaries. 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.

Claim.priority.id 0..1 string Unique id for inter-element referencing

Claim.priority.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

Claim.priority.coding This element is included in summaries. 1..1 Coding Code defined by a terminology system

Claim.priority.coding.id 0..1 string Unique id for inter-element referencing

Claim.priority.coding.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

Claim.priority.coding.system This element is included in summaries. 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority (no extensions allowed)

Claim.priority.coding.version This element is included in summaries. 0..1 string Version of the system - if relevant

Claim.priority.coding.code This element is included in summaries. 1..1 code Symbol in syntax defined by the system

Claim.priority.coding.display This element is included in summaries. 0..1 string Representation defined by the system

Claim.priority.coding.userSelected This element is included in summaries. 0..1 boolean If this coding was chosen directly by the user

Claim.priority.text This element is included in summaries. 0..1 string Plain text representation of the concept

Claim.fundsReserve 0..1 CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

Claim.related 0..* BackboneElement Prior or corollary claims

Claim.related.id 0..1 string Unique id for inter-element referencing

Claim.related.extension 0..* Extension Additional content defined by implementations

Claim.related.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Claim.related.claim 0..1 Reference(Claim) Reference to the related claim

Claim.related.relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

Claim.related.reference 0..1 Identifier File or case reference

Claim.prescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Prescription authorizing services and products

Claim.originalPrescription 0..1 Reference(DeviceRequest | MedicationRequest | VisionPrescription) Original prescription if superseded by fulfiller

Claim.payee 0..1 BackboneElement Recipient of benefits payable

Claim.payee.id 0..1 string Unique id for inter-element referencing

Claim.payee.extension 0..* Extension Additional content defined by implementations

Claim.payee.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Claim.payee.type 1..1 CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

Claim.payee.party 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Recipient reference

Claim.referral This element must be supported. 0..1 Reference(ServiceRequest) Treatment referral

Claim.referral.id 0..1 string Unique id for inter-element referencing

Claim.referral.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

Claim.referral.reference This element is included in summaries. C 1..1 string Literal reference, Relative, internal or absolute URL

Claim.referral.type This element is included in summaries. 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

Claim.referral.identifier This element is included in summaries. 0..1 Identifier Logical reference, when literal reference is not known

Claim.referral.display This element is included in summaries. 0..1 string Text alternative for the resource

Claim.facility 0..1 Reference(Location) Servicing facility

Claim.careTeam 0..* BackboneElement Members of the care team

Claim.careTeam.id 0..1 string Unique id for inter-element referencing

Claim.careTeam.extension 0..* Extension Additional content defined by implementations

Claim.careTeam.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Claim.careTeam.sequence 1..1 positiveInt Order of care team

Claim.careTeam.provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization

Claim.careTeam.responsible 0..1 boolean Indicator of the lead practitioner

Claim.careTeam.role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.

Claim.careTeam.qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

Claim.supportingInfo This element must be supported. 0..* BackboneElement Supporting information

Claim.supportingInfo.id 0..1 string Unique id for inter-element referencing

Claim.supportingInfo.extension 0..* Extension Additional content defined by implementations

Claim.supportingInfo.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Claim.supportingInfo.sequence 1..1 positiveInt Information instance identifier

Claim.supportingInfo.category This element must be supported. 1..1 CodeableConcept Classification of the supplied information
Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.

Claim.supportingInfo.category.id 0..1 string Unique id for inter-element referencing

Claim.supportingInfo.category.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

Claim.supportingInfo.category.coding This element is included in summaries. 1..1 Coding Code defined by a terminology system

Claim.supportingInfo.category.coding.id 0..1 string Unique id for inter-element referencing

Claim.supportingInfo.category.coding.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

Claim.supportingInfo.category.coding.system This element is included in summaries. 1..1 uri Identity of the terminology system

Claim.supportingInfo.category.coding.version This element is included in summaries. 0..1 string Version of the system - if relevant

Claim.supportingInfo.category.coding.code This element is included in summaries. 1..1 code Symbol in syntax defined by the system

Claim.supportingInfo.category.coding.display This element is included in summaries. 0..1 string Representation defined by the system

Claim.supportingInfo.category.coding.userSelected This element is included in summaries. 0..1 boolean If this coding was chosen directly by the user

Claim.supportingInfo.category.text This element is included in summaries. 0..1 string Plain text representation of the concept

Claim.supportingInfo.code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.

Claim.supportingInfo.code.id 0..1 string Unique id for inter-element referencing

Claim.supportingInfo.code.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

Claim.supportingInfo.code.coding This element is included in summaries. 1..1 Coding Code defined by a terminology system

Claim.supportingInfo.code.coding.id 0..1 string Unique id for inter-element referencing

Claim.supportingInfo.code.coding.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

Claim.supportingInfo.code.coding.system This element is included in summaries. 1..1 uri Identity of the terminology system

Claim.supportingInfo.code.coding.version This element is included in summaries. 0..1 string Version of the system - if relevant

Claim.supportingInfo.code.coding.code This element is included in summaries. 1..1 code Symbol in syntax defined by the system

Claim.supportingInfo.code.coding.display This element is included in summaries. 0..1 string Representation defined by the system

Claim.supportingInfo.code.coding.userSelected This element is included in summaries. 0..1 boolean If this coding was chosen directly by the user

Claim.supportingInfo.code.text This element is included in summaries. 0..1 string Plain text representation of the concept

Claim.supportingInfo.timing[x] 0..1 When it occurred

Claim.supportingInfo.timing[x].timingDate date

Claim.supportingInfo.timing[x].timingPeriod Period

Claim.supportingInfo.value[x] 0..1 Data to be provided

Claim.supportingInfo.value[x].valueBoolean boolean

Claim.supportingInfo.value[x].valueString string

Claim.supportingInfo.value[x].valueQuantity Quantity

Claim.supportingInfo.value[x].valueAttachment Attachment

Claim.supportingInfo.value[x].valueReference Reference(Resource)

Claim.supportingInfo.reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.

Claim.diagnosis 0..* BackboneElement Pertinent diagnosis information

Claim.diagnosis.id 0..1 string Unique id for inter-element referencing

Claim.diagnosis.extension 0..* Extension Additional content defined by implementations

Claim.diagnosis.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Claim.diagnosis.sequence 1..1 positiveInt Diagnosis instance identifier

Claim.diagnosis.diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

Claim.diagnosis.diagnosis[x].diagnosisCodeableConcept CodeableConcept

Claim.diagnosis.diagnosis[x].diagnosisReference Reference(Condition)

Claim.diagnosis.type 0..* CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.

Claim.diagnosis.onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

Claim.diagnosis.packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

Claim.procedure 0..* BackboneElement Clinical procedures performed

Claim.procedure.id 0..1 string Unique id for inter-element referencing

Claim.procedure.extension 0..* Extension Additional content defined by implementations

Claim.procedure.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Claim.procedure.sequence 1..1 positiveInt Procedure instance identifier

Claim.procedure.type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.

Claim.procedure.date This element must be supported. 1..1 dateTime When the procedure was performed

Claim.procedure.Slices for procedure[x] 1..1 Specific clinical procedure
Slice: Unordered, Closed by type:$this
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them Other type slices that contain no new information are not shown in this view

Claim.procedure.Slices for procedure[x].procedureCodeableConcept CodeableConcept

Claim.procedure.Slices for procedure[x].procedureReference Reference(Procedure)

procedure[x]:procedureCodeableConcept

0..1

CodeableConcept

Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
Required Pattern:

{
  "coding" : [
    {
      "system" : "http://snomed.info/sct",
      "code" : "386053000"
    }
  ]
}

Claim.procedure.udi 0..* Reference(Device) Unique device identifier

Claim.insurance This element must be supported. This element is included in summaries. 1..1 BackboneElement Patient insurance information

Claim.insurance.id 0..1 string Unique id for inter-element referencing

Claim.insurance.extension 0..* Extension Additional content defined by implementations

Claim.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Claim.insurance.sequence This element is included in summaries. 1..1 positiveInt Insurance instance identifier
Fixed Value: 1 (no extensions allowed)

Claim.insurance.focal This element is included in summaries. 1..1 boolean Coverage to be used for adjudication
Fixed Value: true (no extensions allowed)

Claim.insurance.identifier 0..1 Identifier Pre-assigned Claim number

Claim.insurance.coverage This element is included in summaries. 1..1 Reference(Coverage) Insurance information

Claim.insurance.coverage.id 0..1 string Unique id for inter-element referencing

Claim.insurance.coverage.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

Claim.insurance.coverage.reference This element is included in summaries. C 0..1 string Literal reference, Relative, internal or absolute URL

Claim.insurance.coverage.type This element is included in summaries. 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

Claim.insurance.coverage.identifier This element is included in summaries. 0..1 Identifier Logical reference, when literal reference is not known

Claim.insurance.coverage.display This element is included in summaries. 1..1 string Text alternative for the resource

Claim.insurance.businessArrangement 0..1 string Additional provider contract number

Claim.insurance.preAuthRef 0..* string Prior authorization reference number

Claim.insurance.claimResponse 0..1 Reference(ClaimResponse) Adjudication results

Claim.accident 0..1 BackboneElement Details of the event

Claim.accident.id 0..1 string Unique id for inter-element referencing

Claim.accident.extension 0..* Extension Additional content defined by implementations

Claim.accident.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Claim.accident.date 1..1 date When the incident occurred

Claim.accident.type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.

Claim.accident.location[x] 0..1 Where the event occurred

Claim.accident.location[x].locationAddress Address

Claim.accident.location[x].locationReference Reference(Location)

Claim.item This element must be supported. 0..* BackboneElement Product or service provided

Claim.item.id 0..1 string Unique id for inter-element referencing

Claim.item.extension 0..* Extension Additional content defined by implementations

Claim.item.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Claim.item.sequence 1..1 positiveInt Item instance identifier

Claim.item.careTeamSequence 0..* positiveInt Applicable careTeam members

Claim.item.diagnosisSequence 0..* positiveInt Applicable diagnoses

Claim.item.procedureSequence 0..* positiveInt Applicable procedures

Claim.item.informationSequence 0..* positiveInt Applicable exception and supporting information

Claim.item.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

Claim.item.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

Claim.item.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

Claim.item.productOrService.id 0..1 string Unique id for inter-element referencing

Claim.item.productOrService.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

Claim.item.productOrService.coding This element is included in summaries. 1..1 Coding Code defined by a terminology system
Binding: Speech Therapy Pathology Situation Code (required)

Claim.item.productOrService.coding.id 0..1 string Unique id for inter-element referencing

Claim.item.productOrService.coding.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

Claim.item.productOrService.coding.system This element is included in summaries. 1..1 uri Identity of the terminology system

Claim.item.productOrService.coding.version This element is included in summaries. 0..1 string Version of the system - if relevant

Claim.item.productOrService.coding.code This element is included in summaries. 1..1 code Symbol in syntax defined by the system

Claim.item.productOrService.coding.display This element is included in summaries. 0..1 string Representation defined by the system

Claim.item.productOrService.coding.userSelected This element is included in summaries. 0..1 boolean If this coding was chosen directly by the user

Claim.item.productOrService.text This element is included in summaries. 0..1 string Plain text representation of the concept

Claim.item.modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (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..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.

Claim.item.serviced[x] 0..1 date Date or dates of service or product delivery

Claim.item.location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.

Claim.item.location[x].locationCodeableConcept CodeableConcept

Claim.item.location[x].locationAddress Address

Claim.item.location[x].locationReference Reference(Location)

Claim.item.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1

Claim.item.unitPrice 0..1 Money Fee, charge or cost per item

Claim.item.factor 0..1 decimal Price scaling factor

Claim.item.net 0..1 Money Total item cost

Claim.item.udi 0..* Reference(Device) Unique device identifier

Claim.item.bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

Claim.item.subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (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..* BackboneElement Product or service provided

Claim.item.detail.id 0..1 string Unique id for inter-element referencing

Claim.item.detail.extension 0..* Extension Additional content defined by implementations

Claim.item.detail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Claim.item.detail.sequence 1..1 positiveInt Item instance identifier

Claim.item.detail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

Claim.item.detail.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

Claim.item.detail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

Claim.item.detail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (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..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.

Claim.item.detail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1

Claim.item.detail.unitPrice 0..1 Money Fee, charge or cost per item

Claim.item.detail.factor 0..1 decimal Price scaling factor

Claim.item.detail.net 0..1 Money Total item cost

Claim.item.detail.udi 0..* Reference(Device) Unique device identifier

Claim.item.detail.subDetail 0..* BackboneElement Product or service provided

Claim.item.detail.subDetail.id 0..1 string Unique id for inter-element referencing

Claim.item.detail.subDetail.extension 0..* Extension Additional content defined by implementations

Claim.item.detail.subDetail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Claim.item.detail.subDetail.sequence 1..1 positiveInt Item instance identifier

Claim.item.detail.subDetail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.

Claim.item.detail.subDetail.category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.

Claim.item.detail.subDetail.productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

Claim.item.detail.subDetail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (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..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.

Claim.item.detail.subDetail.quantity C 0..1 SimpleQuantity(4.0.1) Count of products or services
Constraints: sqty-1

Claim.item.detail.subDetail.unitPrice 0..1 Money Fee, charge or cost per item

Claim.item.detail.subDetail.factor 0..1 decimal Price scaling factor

Claim.item.detail.subDetail.net 0..1 Money Total item cost

Claim.item.detail.subDetail.udi 0..* Reference(Device) Unique device identifier

Claim.total 0..1 Money Total claim cost

Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.meta.security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
Claim.meta.tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
Claim.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
Claim.subType	Base	example	Example Claim SubType Codes	📍4.0.1	FHIR Std.
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.enterer.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.provider.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.priority	Base	example	Process Priority Codes	📍4.0.1	FHIR Std.
Claim.fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
Claim.related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.0.1	FHIR Std.
Claim.payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
Claim.referral.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.careTeam.role	Base	example	Claim Care Team Role Codes	📍4.0.1	FHIR Std.
Claim.careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.0.1	FHIR Std.
Claim.procedure.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]:procedureCodeableConcept	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.insurance.coverage.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.accident.type	Base	extensible	ActIncidentCode	📦3.0.0	THO v7.5
Claim.item.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.productOrService.coding	Base	required	Speech Therapy Pathology Situation Code	📦1.1.0	HL7 Belgium NIHDI Terminology v1.1
Claim.item.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
Claim.item.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
Claim.item.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
Claim.item.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
Claim.item.detail.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
be-rule-eagreementclaim-1	error	Claim	Billable period start and end SHALL be YYYY-MM-DD	`(Claim.billablePeriod.start.exists() implies Claim.billablePeriod.start.toString().length()=10) and (Claim.billablePeriod.end.exists() implies Claim.billablePeriod.end.toString().length()=10)`
be-rule-eagreementclaim-2	error	Claim	Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz	`Claim.created.toString().length()=25`
be-rule-eagreementclaim-3	error	Claim	Procedure.date SHALL be YYYY-MM-DD	`Claim.procedure.date.exists() implies Claim.procedure.date.select(toString().length()=10).allTrue()`
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	`contained.contained.empty()`
dom-3	error	Claim	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	`contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	`contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	`contained.meta.security.empty()`
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children	`hasValue() or (children().count() > id.count())`
ext-1	error	ALL extensions	Must have either extensions or value[x], not both	`extension.exists() != value.exists()`
sqty-1	error	Claim.item.quantity, Claim.item.detail.quantity, Claim.item.detail.subDetail.quantity	The comparator is not used on a SimpleQuantity	`comparator.empty()`

This structure is derived from BeMyCareNetEagreementClaim

Summary

Mandatory: 0 element(1 nested mandatory element)
Must-Support: 1 element

Slices

This structure defines the following Slices:

The element 1 is sliced based on the value of Claim.procedure.procedure[x]

Maturity: 1

Key Elements View

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Claim	C	0..*	BeMyCareNetEagreementClaim	Claim, Pre-determination or Pre-authorization Constraints: be-rule-eagreementclaim-1, be-rule-eagreementclaim-2, be-rule-eagreementclaim-3
Claim.id	This element must be supported. This element is included in summaries.	1..1	id	Logical id of this artifact
Claim.meta	This element must be supported. This element is included in summaries.	1..1	Meta	Metadata about the resource
Claim.meta.profile	This element is included in summaries.	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Claim.implicitRules	This element is a modifier element. This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Claim.modifierExtension	This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.status	This element is a modifier element. This element must be supported. This element is included in summaries.	1..1	code	active \| cancelled \| draft \| entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active (no extensions allowed)
Claim.type	This element must be supported. This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Claim.type.coding	This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.type.coding.system	This element is included in summaries.	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type (no extensions allowed)
Claim.type.coding.code	This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.subType	This element must be supported.	1..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
Claim.subType.coding	This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.subType.coding.system	This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types (extensions allowed)
Claim.subType.coding.code	This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.use	This element must be supported. This element is included in summaries.	1..1	code	claim \| preauthorization \| predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Fixed Value: preauthorization (no extensions allowed)
Claim.patient	This element must be supported. This element is included in summaries.	1..1	Reference(BePatient)	The recipient of the products and services
Claim.billablePeriod	This element must be supported. This element is included in summaries.	0..1	Period	Relevant time frame for the claim
Claim.created	This element must be supported. This element is included in summaries.	1..1	dateTime	Resource creation date
Claim.enterer	This element must be supported.	0..1	Reference(BePractitionerRole)	Author of the claim
Claim.enterer.reference	This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Claim.provider	This element must be supported. This element is included in summaries.	1..1	Reference(BeOrganization \| BePractitionerRole)	Party responsible for the claim
Claim.provider.reference	This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Claim.priority	This element must be supported. This element is included in summaries.	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
Claim.priority.coding	This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.priority.coding.system	This element is included in summaries.	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/processpriority (no extensions allowed)
Claim.priority.coding.code	This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.referral	This element must be supported.	0..1	Reference(ServiceRequest)	Treatment referral
Claim.referral.reference	This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Claim.supportingInfo	This element must be supported.	0..*	BackboneElement	Supporting information
Claim.supportingInfo.modifierExtension	This element is a modifier element. This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.supportingInfo.sequence		1..1	positiveInt	Information instance identifier
Claim.supportingInfo.category	This element must be supported.	1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
Claim.supportingInfo.category.coding	This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.supportingInfo.category.coding.system	This element is included in summaries.	1..1	uri	Identity of the terminology system
Claim.supportingInfo.category.coding.code	This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.procedure		0..*	BackboneElement	Clinical procedures performed
Claim.procedure.modifierExtension	This element is a modifier element. This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.procedure.sequence		1..1	positiveInt	Procedure instance identifier
Claim.procedure.date	This element must be supported.	1..1	dateTime	When the procedure was performed
Claim.procedure.Slices for procedure[x]		1..1		Specific clinical procedure Slice: Unordered, Closed by type:$this Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them Other type slices that contain no new information are not shown in this view
Claim.procedure.Slices for procedure[x].procedureCodeableConcept			CodeableConcept
Claim.procedure.Slices for procedure[x].procedureReference			Reference(Procedure)
Claim.procedure.Slices for procedure[x].procedure[x]:procedureCodeableConcept		0..1	CodeableConcept	Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes. Required Pattern: `{ "coding" : [ { "system" : "http://snomed.info/sct", "code" : "386053000" } ] }`
Claim.insurance	This element must be supported. This element is included in summaries.	1..1	BackboneElement	Patient insurance information
Claim.insurance.modifierExtension	This element is a modifier element. This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence	This element is included in summaries.	1..1	positiveInt	Insurance instance identifier Fixed Value: 1 (no extensions allowed)
Claim.insurance.focal	This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication Fixed Value: true (no extensions allowed)
Claim.insurance.coverage	This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Claim.insurance.coverage.display	This element is included in summaries.	1..1	string	Text alternative for the resource
Claim.item	This element must be supported.	0..*	BackboneElement	Product or service provided
Claim.item.modifierExtension	This element is a modifier element. This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.sequence		1..1	positiveInt	Item instance identifier
Claim.item.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.productOrService.coding	This element is included in summaries.	1..1	Coding	Code defined by a terminology system Binding: Speech Therapy Pathology Situation Code (required)
Claim.item.productOrService.coding.system	This element is included in summaries.	1..1	uri	Identity of the terminology system
Claim.item.productOrService.coding.code	This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
Claim.subType	Base	example	Example Claim SubType Codes	📍4.0.1	FHIR Std.
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.priority	Base	example	Process Priority Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]:procedureCodeableConcept	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.productOrService.coding	Base	required	Speech Therapy Pathology Situation Code	📦1.1.0	HL7 Belgium NIHDI Terminology v1.1

Constraints

Id	Grade	Path(s)	Description	Expression
be-rule-eagreementclaim-1	error	Claim	Billable period start and end SHALL be YYYY-MM-DD	`(Claim.billablePeriod.start.exists() implies Claim.billablePeriod.start.toString().length()=10) and (Claim.billablePeriod.end.exists() implies Claim.billablePeriod.end.toString().length()=10)`
be-rule-eagreementclaim-2	error	Claim	Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz	`Claim.created.toString().length()=25`
be-rule-eagreementclaim-3	error	Claim	Procedure.date SHALL be YYYY-MM-DD	`Claim.procedure.date.exists() implies Claim.procedure.date.select(toString().length()=10).allTrue()`
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	`contained.contained.empty()`
dom-3	error	Claim	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	`contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	`contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	`contained.meta.security.empty()`
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children	`hasValue() or (children().count() > id.count())`
ext-1	error	ALL extensions	Must have either extensions or value[x], not both	`extension.exists() != value.exists()`

Differential View

This structure is derived from BeMyCareNetEagreementClaim

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Claim		0..*	BeMyCareNetEagreementClaim	Claim, Pre-determination or Pre-authorization
Claim.procedure
Claim.procedure.date	This element must be supported.	1..1	dateTime	When the procedure was performed
Claim.procedure.Slices for procedure[x]		1..1	CodeableConcept, Reference(Procedure)	Specific clinical procedure Slice: Unordered, Open by type:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them Other type slices that contain no new information are not shown in this view
Claim.procedure.Slices for procedure[x].procedure[x]:procedureCodeableConcept		0..1	CodeableConcept	Specific clinical procedure Required Pattern: `{ "coding" : [ { "system" : "http://snomed.info/sct", "code" : "386053000" } ] }`
Claim.item
Claim.item.productOrService
Claim.item.productOrService.coding		1..1	Coding	Code defined by a terminology system Binding: Speech Therapy Pathology Situation Code (required)
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Claim.item.productOrService.coding	Base	required	Speech Therapy Pathology Situation Code	📦1.1.0	HL7 Belgium NIHDI Terminology v1.1

Snapshot ViewView