Claim

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

Columns

Header row
# path type required description
0 resourceType string * Resource type identifier. Must be string "Claim"
1 integer * Number of subrows
2 id string * Logical id of this artifact
3 status code active | cancelled | draft | entered-in-error
type CodeableConcept Category or discipline
type.coding Coding Code defined by a terminology system
4 type.coding.system uri Identity of the terminology system
5 type.coding.version string Version of the system - if relevant
6 type.coding.code code Symbol in syntax defined by the system
7 type.coding.display string Representation defined by the system
8 type.coding.userSelected boolean If this coding was chosen directly by the user
9 type.text string Plain text representation of the concept
subType CodeableConcept More granular claim type
subType.coding Coding Code defined by a terminology system
10 subType.coding.system uri Identity of the terminology system
11 subType.coding.version string Version of the system - if relevant
12 subType.coding.code code Symbol in syntax defined by the system
13 subType.coding.display string Representation defined by the system
14 subType.coding.userSelected boolean If this coding was chosen directly by the user
15 subType.text string Plain text representation of the concept
16 use code claim | preauthorization | predetermination
patient Reference The recipient of the products and services
17 patient.reference string Literal reference, Relative, internal or absolute URL
18 patient.type uri Type the reference refers to (e.g. "Patient")
patient.identifier Identifier Logical reference, when literal reference is not known
19 patient.identifier.use code usual | official | temp | secondary | old (If known)
patient.identifier.type CodeableConcept Description of identifier
patient.identifier.type.coding Coding Code defined by a terminology system
20 patient.identifier.type.coding.system uri Identity of the terminology system
21 patient.identifier.type.coding.version string Version of the system - if relevant
22 patient.identifier.type.coding.code code Symbol in syntax defined by the system
23 patient.identifier.type.coding.display string Representation defined by the system
24 patient.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
25 patient.identifier.type.text string Plain text representation of the concept
26 patient.identifier.system uri The namespace for the identifier value
27 patient.identifier.value string The value that is unique
patient.identifier.period Period Time period when id is/was valid for use
28 patient.identifier.period.start dateTime Starting time with inclusive boundary
29 patient.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
30 patient.display string Text alternative for the resource
billablePeriod Period Relevant time frame for the claim
31 billablePeriod.start dateTime Starting time with inclusive boundary
32 billablePeriod.end dateTime End time with inclusive boundary, if not ongoing
33 created dateTime Resource creation date
enterer Reference Author of the claim
34 enterer.reference string Literal reference, Relative, internal or absolute URL
35 enterer.type uri Type the reference refers to (e.g. "Patient")
enterer.identifier Identifier Logical reference, when literal reference is not known
36 enterer.identifier.use code usual | official | temp | secondary | old (If known)
enterer.identifier.type CodeableConcept Description of identifier
enterer.identifier.type.coding Coding Code defined by a terminology system
37 enterer.identifier.type.coding.system uri Identity of the terminology system
38 enterer.identifier.type.coding.version string Version of the system - if relevant
39 enterer.identifier.type.coding.code code Symbol in syntax defined by the system
40 enterer.identifier.type.coding.display string Representation defined by the system
41 enterer.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
42 enterer.identifier.type.text string Plain text representation of the concept
43 enterer.identifier.system uri The namespace for the identifier value
44 enterer.identifier.value string The value that is unique
enterer.identifier.period Period Time period when id is/was valid for use
45 enterer.identifier.period.start dateTime Starting time with inclusive boundary
46 enterer.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
47 enterer.display string Text alternative for the resource
insurer Reference Target
48 insurer.reference string Literal reference, Relative, internal or absolute URL
49 insurer.type uri Type the reference refers to (e.g. "Patient")
insurer.identifier Identifier Logical reference, when literal reference is not known
50 insurer.identifier.use code usual | official | temp | secondary | old (If known)
insurer.identifier.type CodeableConcept Description of identifier
insurer.identifier.type.coding Coding Code defined by a terminology system
51 insurer.identifier.type.coding.system uri Identity of the terminology system
52 insurer.identifier.type.coding.version string Version of the system - if relevant
53 insurer.identifier.type.coding.code code Symbol in syntax defined by the system
54 insurer.identifier.type.coding.display string Representation defined by the system
55 insurer.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
56 insurer.identifier.type.text string Plain text representation of the concept
57 insurer.identifier.system uri The namespace for the identifier value
58 insurer.identifier.value string The value that is unique
insurer.identifier.period Period Time period when id is/was valid for use
59 insurer.identifier.period.start dateTime Starting time with inclusive boundary
60 insurer.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
61 insurer.display string Text alternative for the resource
provider Reference Party responsible for the claim
62 provider.reference string Literal reference, Relative, internal or absolute URL
63 provider.type uri Type the reference refers to (e.g. "Patient")
provider.identifier Identifier Logical reference, when literal reference is not known
64 provider.identifier.use code usual | official | temp | secondary | old (If known)
provider.identifier.type CodeableConcept Description of identifier
provider.identifier.type.coding Coding Code defined by a terminology system
65 provider.identifier.type.coding.system uri Identity of the terminology system
66 provider.identifier.type.coding.version string Version of the system - if relevant
67 provider.identifier.type.coding.code code Symbol in syntax defined by the system
68 provider.identifier.type.coding.display string Representation defined by the system
69 provider.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
70 provider.identifier.type.text string Plain text representation of the concept
71 provider.identifier.system uri The namespace for the identifier value
72 provider.identifier.value string The value that is unique
provider.identifier.period Period Time period when id is/was valid for use
73 provider.identifier.period.start dateTime Starting time with inclusive boundary
74 provider.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
75 provider.display string Text alternative for the resource
priority CodeableConcept Desired processing ugency
priority.coding Coding Code defined by a terminology system
76 priority.coding.system uri Identity of the terminology system
77 priority.coding.version string Version of the system - if relevant
78 priority.coding.code code Symbol in syntax defined by the system
79 priority.coding.display string Representation defined by the system
80 priority.coding.userSelected boolean If this coding was chosen directly by the user
81 priority.text string Plain text representation of the concept
fundsReserve CodeableConcept For whom to reserve funds
fundsReserve.coding Coding Code defined by a terminology system
82 fundsReserve.coding.system uri Identity of the terminology system
83 fundsReserve.coding.version string Version of the system - if relevant
84 fundsReserve.coding.code code Symbol in syntax defined by the system
85 fundsReserve.coding.display string Representation defined by the system
86 fundsReserve.coding.userSelected boolean If this coding was chosen directly by the user
87 fundsReserve.text string Plain text representation of the concept
prescription Reference Prescription authorizing services and products
88 prescription.reference string Literal reference, Relative, internal or absolute URL
89 prescription.type uri Type the reference refers to (e.g. "Patient")
prescription.identifier Identifier Logical reference, when literal reference is not known
90 prescription.identifier.use code usual | official | temp | secondary | old (If known)
prescription.identifier.type CodeableConcept Description of identifier
prescription.identifier.type.coding Coding Code defined by a terminology system
91 prescription.identifier.type.coding.system uri Identity of the terminology system
92 prescription.identifier.type.coding.version string Version of the system - if relevant
93 prescription.identifier.type.coding.code code Symbol in syntax defined by the system
94 prescription.identifier.type.coding.display string Representation defined by the system
95 prescription.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
96 prescription.identifier.type.text string Plain text representation of the concept
97 prescription.identifier.system uri The namespace for the identifier value
98 prescription.identifier.value string The value that is unique
prescription.identifier.period Period Time period when id is/was valid for use
99 prescription.identifier.period.start dateTime Starting time with inclusive boundary
100 prescription.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
101 prescription.display string Text alternative for the resource
originalPrescription Reference Original prescription if superseded by fulfiller
102 originalPrescription.reference string Literal reference, Relative, internal or absolute URL
103 originalPrescription.type uri Type the reference refers to (e.g. "Patient")
originalPrescription.identifier Identifier Logical reference, when literal reference is not known
104 originalPrescription.identifier.use code usual | official | temp | secondary | old (If known)
originalPrescription.identifier.type CodeableConcept Description of identifier
originalPrescription.identifier.type.coding Coding Code defined by a terminology system
105 originalPrescription.identifier.type.coding.system uri Identity of the terminology system
106 originalPrescription.identifier.type.coding.version string Version of the system - if relevant
107 originalPrescription.identifier.type.coding.code code Symbol in syntax defined by the system
108 originalPrescription.identifier.type.coding.display string Representation defined by the system
109 originalPrescription.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
110 originalPrescription.identifier.type.text string Plain text representation of the concept
111 originalPrescription.identifier.system uri The namespace for the identifier value
112 originalPrescription.identifier.value string The value that is unique
originalPrescription.identifier.period Period Time period when id is/was valid for use
113 originalPrescription.identifier.period.start dateTime Starting time with inclusive boundary
114 originalPrescription.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
115 originalPrescription.display string Text alternative for the resource
payee Recipient of benefits payable
payee.type CodeableConcept Category of recipient
payee.type.coding Coding Code defined by a terminology system
116 payee.type.coding.system uri Identity of the terminology system
117 payee.type.coding.version string Version of the system - if relevant
118 payee.type.coding.code code Symbol in syntax defined by the system
119 payee.type.coding.display string Representation defined by the system
120 payee.type.coding.userSelected boolean If this coding was chosen directly by the user
121 payee.type.text string Plain text representation of the concept
payee.party Reference Recipient reference
122 payee.party.reference string Literal reference, Relative, internal or absolute URL
123 payee.party.type uri Type the reference refers to (e.g. "Patient")
payee.party.identifier Identifier Logical reference, when literal reference is not known
124 payee.party.identifier.use code usual | official | temp | secondary | old (If known)
payee.party.identifier.type CodeableConcept Description of identifier
payee.party.identifier.type.coding Coding Code defined by a terminology system
125 payee.party.identifier.type.coding.system uri Identity of the terminology system
126 payee.party.identifier.type.coding.version string Version of the system - if relevant
127 payee.party.identifier.type.coding.code code Symbol in syntax defined by the system
128 payee.party.identifier.type.coding.display string Representation defined by the system
129 payee.party.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
130 payee.party.identifier.type.text string Plain text representation of the concept
131 payee.party.identifier.system uri The namespace for the identifier value
132 payee.party.identifier.value string The value that is unique
payee.party.identifier.period Period Time period when id is/was valid for use
133 payee.party.identifier.period.start dateTime Starting time with inclusive boundary
134 payee.party.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
135 payee.party.display string Text alternative for the resource
referral Reference Treatment referral
136 referral.reference string Literal reference, Relative, internal or absolute URL
137 referral.type uri Type the reference refers to (e.g. "Patient")
referral.identifier Identifier Logical reference, when literal reference is not known
138 referral.identifier.use code usual | official | temp | secondary | old (If known)
referral.identifier.type CodeableConcept Description of identifier
referral.identifier.type.coding Coding Code defined by a terminology system
139 referral.identifier.type.coding.system uri Identity of the terminology system
140 referral.identifier.type.coding.version string Version of the system - if relevant
141 referral.identifier.type.coding.code code Symbol in syntax defined by the system
142 referral.identifier.type.coding.display string Representation defined by the system
143 referral.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
144 referral.identifier.type.text string Plain text representation of the concept
145 referral.identifier.system uri The namespace for the identifier value
146 referral.identifier.value string The value that is unique
referral.identifier.period Period Time period when id is/was valid for use
147 referral.identifier.period.start dateTime Starting time with inclusive boundary
148 referral.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
149 referral.display string Text alternative for the resource
facility Reference Servicing facility
150 facility.reference string Literal reference, Relative, internal or absolute URL
151 facility.type uri Type the reference refers to (e.g. "Patient")
facility.identifier Identifier Logical reference, when literal reference is not known
152 facility.identifier.use code usual | official | temp | secondary | old (If known)
facility.identifier.type CodeableConcept Description of identifier
facility.identifier.type.coding Coding Code defined by a terminology system
153 facility.identifier.type.coding.system uri Identity of the terminology system
154 facility.identifier.type.coding.version string Version of the system - if relevant
155 facility.identifier.type.coding.code code Symbol in syntax defined by the system
156 facility.identifier.type.coding.display string Representation defined by the system
157 facility.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
158 facility.identifier.type.text string Plain text representation of the concept
159 facility.identifier.system uri The namespace for the identifier value
160 facility.identifier.value string The value that is unique
facility.identifier.period Period Time period when id is/was valid for use
161 facility.identifier.period.start dateTime Starting time with inclusive boundary
162 facility.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
163 facility.display string Text alternative for the resource
accident Details of the event
164 accident.date date When the incident occurred
accident.type CodeableConcept The nature of the accident
accident.type.coding Coding Code defined by a terminology system
165 accident.type.coding.system uri Identity of the terminology system
166 accident.type.coding.version string Version of the system - if relevant
167 accident.type.coding.code code Symbol in syntax defined by the system
168 accident.type.coding.display string Representation defined by the system
169 accident.type.coding.userSelected boolean If this coding was chosen directly by the user
170 accident.type.text string Plain text representation of the concept
accident.location[x] Where the event occurred
accident.locationAddress Address
171 accident.locationAddress.use code home | work | temp | old | billing - purpose of this address
172 accident.locationAddress.type code postal | physical | both
173 accident.locationAddress.text string Text representation of the address
174 accident.locationAddress.line string Street name, number, direction & P.O. Box etc.
175 accident.locationAddress.city string Name of city, town etc.
176 accident.locationAddress.district string District name (aka county)
177 accident.locationAddress.state string Sub-unit of country (abbreviations ok)
178 accident.locationAddress.postalCode string Postal code for area
179 accident.locationAddress.country string Country (e.g. can be ISO 3166 2 or 3 letter code)
accident.locationAddress.period Period Time period when address was/is in use
180 accident.locationAddress.period.start dateTime Starting time with inclusive boundary
181 accident.locationAddress.period.end dateTime End time with inclusive boundary, if not ongoing
accident.locationReference Reference
182 accident.locationReference.reference string Literal reference, Relative, internal or absolute URL
183 accident.locationReference.type uri Type the reference refers to (e.g. "Patient")
accident.locationReference.identifier Identifier Logical reference, when literal reference is not known
184 accident.locationReference.identifier.use code usual | official | temp | secondary | old (If known)
accident.locationReference.identifier.type CodeableConcept Description of identifier
accident.locationReference.identifier.type.coding Coding Code defined by a terminology system
185 accident.locationReference.identifier.type.coding.system uri Identity of the terminology system
186 accident.locationReference.identifier.type.coding.version string Version of the system - if relevant
187 accident.locationReference.identifier.type.coding.code code Symbol in syntax defined by the system
188 accident.locationReference.identifier.type.coding.display string Representation defined by the system
189 accident.locationReference.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
190 accident.locationReference.identifier.type.text string Plain text representation of the concept
191 accident.locationReference.identifier.system uri The namespace for the identifier value
192 accident.locationReference.identifier.value string The value that is unique
accident.locationReference.identifier.period Period Time period when id is/was valid for use
193 accident.locationReference.identifier.period.start dateTime Starting time with inclusive boundary
194 accident.locationReference.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
195 accident.locationReference.display string Text alternative for the resource
total Money Total claim cost
196 total.value decimal Numerical value (with implicit precision)
197 total.currency code ISO 4217 Currency Code
Row identifier
# path type required description
0 string * Subrow identifier. Must be string "identifier"
identifier Identifier Business Identifier for claim
1 identifier.use code usual | official | temp | secondary | old (If known)
identifier.type CodeableConcept Description of identifier
identifier.type.coding Coding Code defined by a terminology system
2 identifier.type.coding.system uri Identity of the terminology system
3 identifier.type.coding.version string Version of the system - if relevant
4 identifier.type.coding.code code Symbol in syntax defined by the system
5 identifier.type.coding.display string Representation defined by the system
6 identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
7 identifier.type.text string Plain text representation of the concept
8 identifier.system uri The namespace for the identifier value
9 identifier.value string The value that is unique
identifier.period Period Time period when id is/was valid for use
10 identifier.period.start dateTime Starting time with inclusive boundary
11 identifier.period.end dateTime End time with inclusive boundary, if not ongoing
Row related
# path type required description
0 string * Subrow identifier. Must be string "related"
related Prior or corollary claims
related.claim Reference Reference to the related claim
1 related.claim.reference string Literal reference, Relative, internal or absolute URL
2 related.claim.type uri Type the reference refers to (e.g. "Patient")
related.claim.identifier Identifier Logical reference, when literal reference is not known
3 related.claim.identifier.use code usual | official | temp | secondary | old (If known)
related.claim.identifier.type CodeableConcept Description of identifier
related.claim.identifier.type.coding Coding Code defined by a terminology system
4 related.claim.identifier.type.coding.system uri Identity of the terminology system
5 related.claim.identifier.type.coding.version string Version of the system - if relevant
6 related.claim.identifier.type.coding.code code Symbol in syntax defined by the system
7 related.claim.identifier.type.coding.display string Representation defined by the system
8 related.claim.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
9 related.claim.identifier.type.text string Plain text representation of the concept
10 related.claim.identifier.system uri The namespace for the identifier value
11 related.claim.identifier.value string The value that is unique
related.claim.identifier.period Period Time period when id is/was valid for use
12 related.claim.identifier.period.start dateTime Starting time with inclusive boundary
13 related.claim.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
14 related.claim.display string Text alternative for the resource
related.relationship CodeableConcept How the reference claim is related
related.relationship.coding Coding Code defined by a terminology system
15 related.relationship.coding.system uri Identity of the terminology system
16 related.relationship.coding.version string Version of the system - if relevant
17 related.relationship.coding.code code Symbol in syntax defined by the system
18 related.relationship.coding.display string Representation defined by the system
19 related.relationship.coding.userSelected boolean If this coding was chosen directly by the user
20 related.relationship.text string Plain text representation of the concept
related.reference Identifier File or case reference
21 related.reference.use code usual | official | temp | secondary | old (If known)
related.reference.type CodeableConcept Description of identifier
related.reference.type.coding Coding Code defined by a terminology system
22 related.reference.type.coding.system uri Identity of the terminology system
23 related.reference.type.coding.version string Version of the system - if relevant
24 related.reference.type.coding.code code Symbol in syntax defined by the system
25 related.reference.type.coding.display string Representation defined by the system
26 related.reference.type.coding.userSelected boolean If this coding was chosen directly by the user
27 related.reference.type.text string Plain text representation of the concept
28 related.reference.system uri The namespace for the identifier value
29 related.reference.value string The value that is unique
related.reference.period Period Time period when id is/was valid for use
30 related.reference.period.start dateTime Starting time with inclusive boundary
31 related.reference.period.end dateTime End time with inclusive boundary, if not ongoing
Row careTeam
# path type required description
0 string * Subrow identifier. Must be string "careTeam"
careTeam Members of the care team
1 careTeam.sequence positiveInt Order of care team
careTeam.provider Reference Practitioner or organization
2 careTeam.provider.reference string Literal reference, Relative, internal or absolute URL
3 careTeam.provider.type uri Type the reference refers to (e.g. "Patient")
careTeam.provider.identifier Identifier Logical reference, when literal reference is not known
4 careTeam.provider.identifier.use code usual | official | temp | secondary | old (If known)
careTeam.provider.identifier.type CodeableConcept Description of identifier
careTeam.provider.identifier.type.coding Coding Code defined by a terminology system
5 careTeam.provider.identifier.type.coding.system uri Identity of the terminology system
6 careTeam.provider.identifier.type.coding.version string Version of the system - if relevant
7 careTeam.provider.identifier.type.coding.code code Symbol in syntax defined by the system
8 careTeam.provider.identifier.type.coding.display string Representation defined by the system
9 careTeam.provider.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
10 careTeam.provider.identifier.type.text string Plain text representation of the concept
11 careTeam.provider.identifier.system uri The namespace for the identifier value
12 careTeam.provider.identifier.value string The value that is unique
careTeam.provider.identifier.period Period Time period when id is/was valid for use
13 careTeam.provider.identifier.period.start dateTime Starting time with inclusive boundary
14 careTeam.provider.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
15 careTeam.provider.display string Text alternative for the resource
16 careTeam.responsible boolean Indicator of the lead practitioner
careTeam.role CodeableConcept Function within the team
careTeam.role.coding Coding Code defined by a terminology system
17 careTeam.role.coding.system uri Identity of the terminology system
18 careTeam.role.coding.version string Version of the system - if relevant
19 careTeam.role.coding.code code Symbol in syntax defined by the system
20 careTeam.role.coding.display string Representation defined by the system
21 careTeam.role.coding.userSelected boolean If this coding was chosen directly by the user
22 careTeam.role.text string Plain text representation of the concept
careTeam.qualification CodeableConcept Practitioner credential or specialization
careTeam.qualification.coding Coding Code defined by a terminology system
23 careTeam.qualification.coding.system uri Identity of the terminology system
24 careTeam.qualification.coding.version string Version of the system - if relevant
25 careTeam.qualification.coding.code code Symbol in syntax defined by the system
26 careTeam.qualification.coding.display string Representation defined by the system
27 careTeam.qualification.coding.userSelected boolean If this coding was chosen directly by the user
28 careTeam.qualification.text string Plain text representation of the concept
Row supportingInfo
# path type required description
0 string * Subrow identifier. Must be string "supportingInfo"
supportingInfo Supporting information
1 supportingInfo.sequence positiveInt Information instance identifier
supportingInfo.category CodeableConcept Classification of the supplied information
supportingInfo.category.coding Coding Code defined by a terminology system
2 supportingInfo.category.coding.system uri Identity of the terminology system
3 supportingInfo.category.coding.version string Version of the system - if relevant
4 supportingInfo.category.coding.code code Symbol in syntax defined by the system
5 supportingInfo.category.coding.display string Representation defined by the system
6 supportingInfo.category.coding.userSelected boolean If this coding was chosen directly by the user
7 supportingInfo.category.text string Plain text representation of the concept
supportingInfo.code CodeableConcept Type of information
supportingInfo.code.coding Coding Code defined by a terminology system
8 supportingInfo.code.coding.system uri Identity of the terminology system
9 supportingInfo.code.coding.version string Version of the system - if relevant
10 supportingInfo.code.coding.code code Symbol in syntax defined by the system
11 supportingInfo.code.coding.display string Representation defined by the system
12 supportingInfo.code.coding.userSelected boolean If this coding was chosen directly by the user
13 supportingInfo.code.text string Plain text representation of the concept
supportingInfo.timing[x] When it occurred
14 supportingInfo.timingDate date
supportingInfo.timingPeriod Period
15 supportingInfo.timingPeriod.start dateTime Starting time with inclusive boundary
16 supportingInfo.timingPeriod.end dateTime End time with inclusive boundary, if not ongoing
supportingInfo.value[x] Data to be provided
17 supportingInfo.valueBoolean boolean
18 supportingInfo.valueString string
supportingInfo.valueQuantity Quantity
19 supportingInfo.valueQuantity.value decimal Numerical value (with implicit precision)
20 supportingInfo.valueQuantity.comparator code < | <= | >= | > - how to understand the value
21 supportingInfo.valueQuantity.unit string Unit representation
22 supportingInfo.valueQuantity.system uri System that defines coded unit form
23 supportingInfo.valueQuantity.code code Coded form of the unit
supportingInfo.valueAttachment Attachment
24 supportingInfo.valueAttachment.contentType code Mime type of the content, with charset etc.
25 supportingInfo.valueAttachment.language code Human language of the content (BCP-47)
26 supportingInfo.valueAttachment.data base64Binary Data inline, base64ed
27 supportingInfo.valueAttachment.url url Uri where the data can be found
28 supportingInfo.valueAttachment.size unsignedInt Number of bytes of content (if url provided)
29 supportingInfo.valueAttachment.hash base64Binary Hash of the data (sha-1, base64ed)
30 supportingInfo.valueAttachment.title string Label to display in place of the data
31 supportingInfo.valueAttachment.creation dateTime Date attachment was first created
supportingInfo.valueReference Reference
32 supportingInfo.valueReference.reference string Literal reference, Relative, internal or absolute URL
33 supportingInfo.valueReference.type uri Type the reference refers to (e.g. "Patient")
supportingInfo.valueReference.identifier Identifier Logical reference, when literal reference is not known
34 supportingInfo.valueReference.identifier.use code usual | official | temp | secondary | old (If known)
supportingInfo.valueReference.identifier.type CodeableConcept Description of identifier
supportingInfo.valueReference.identifier.type.coding Coding Code defined by a terminology system
35 supportingInfo.valueReference.identifier.type.coding.system uri Identity of the terminology system
36 supportingInfo.valueReference.identifier.type.coding.version string Version of the system - if relevant
37 supportingInfo.valueReference.identifier.type.coding.code code Symbol in syntax defined by the system
38 supportingInfo.valueReference.identifier.type.coding.display string Representation defined by the system
39 supportingInfo.valueReference.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
40 supportingInfo.valueReference.identifier.type.text string Plain text representation of the concept
41 supportingInfo.valueReference.identifier.system uri The namespace for the identifier value
42 supportingInfo.valueReference.identifier.value string The value that is unique
supportingInfo.valueReference.identifier.period Period Time period when id is/was valid for use
43 supportingInfo.valueReference.identifier.period.start dateTime Starting time with inclusive boundary
44 supportingInfo.valueReference.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
45 supportingInfo.valueReference.display string Text alternative for the resource
supportingInfo.reason CodeableConcept Explanation for the information
supportingInfo.reason.coding Coding Code defined by a terminology system
46 supportingInfo.reason.coding.system uri Identity of the terminology system
47 supportingInfo.reason.coding.version string Version of the system - if relevant
48 supportingInfo.reason.coding.code code Symbol in syntax defined by the system
49 supportingInfo.reason.coding.display string Representation defined by the system
50 supportingInfo.reason.coding.userSelected boolean If this coding was chosen directly by the user
51 supportingInfo.reason.text string Plain text representation of the concept
Row diagnosis
# path type required description
0 string * Subrow identifier. Must be string "diagnosis"
diagnosis Pertinent diagnosis information
1 diagnosis.sequence positiveInt Diagnosis instance identifier
diagnosis.diagnosis[x] Nature of illness or problem
diagnosis.diagnosisCodeableConcept CodeableConcept
diagnosis.diagnosisCodeableConcept.coding Coding Code defined by a terminology system
2 diagnosis.diagnosisCodeableConcept.coding.system uri Identity of the terminology system
3 diagnosis.diagnosisCodeableConcept.coding.version string Version of the system - if relevant
4 diagnosis.diagnosisCodeableConcept.coding.code code Symbol in syntax defined by the system
5 diagnosis.diagnosisCodeableConcept.coding.display string Representation defined by the system
6 diagnosis.diagnosisCodeableConcept.coding.userSelected boolean If this coding was chosen directly by the user
7 diagnosis.diagnosisCodeableConcept.text string Plain text representation of the concept
diagnosis.diagnosisReference Reference
8 diagnosis.diagnosisReference.reference string Literal reference, Relative, internal or absolute URL
9 diagnosis.diagnosisReference.type uri Type the reference refers to (e.g. "Patient")
diagnosis.diagnosisReference.identifier Identifier Logical reference, when literal reference is not known
10 diagnosis.diagnosisReference.identifier.use code usual | official | temp | secondary | old (If known)
diagnosis.diagnosisReference.identifier.type CodeableConcept Description of identifier
diagnosis.diagnosisReference.identifier.type.coding Coding Code defined by a terminology system
11 diagnosis.diagnosisReference.identifier.type.coding.system uri Identity of the terminology system
12 diagnosis.diagnosisReference.identifier.type.coding.version string Version of the system - if relevant
13 diagnosis.diagnosisReference.identifier.type.coding.code code Symbol in syntax defined by the system
14 diagnosis.diagnosisReference.identifier.type.coding.display string Representation defined by the system
15 diagnosis.diagnosisReference.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
16 diagnosis.diagnosisReference.identifier.type.text string Plain text representation of the concept
17 diagnosis.diagnosisReference.identifier.system uri The namespace for the identifier value
18 diagnosis.diagnosisReference.identifier.value string The value that is unique
diagnosis.diagnosisReference.identifier.period Period Time period when id is/was valid for use
19 diagnosis.diagnosisReference.identifier.period.start dateTime Starting time with inclusive boundary
20 diagnosis.diagnosisReference.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
21 diagnosis.diagnosisReference.display string Text alternative for the resource
diagnosis.type CodeableConcept Timing or nature of the diagnosis
diagnosis.type.coding Coding Code defined by a terminology system
22 diagnosis.type.coding.system uri Identity of the terminology system
23 diagnosis.type.coding.version string Version of the system - if relevant
24 diagnosis.type.coding.code code Symbol in syntax defined by the system
25 diagnosis.type.coding.display string Representation defined by the system
26 diagnosis.type.coding.userSelected boolean If this coding was chosen directly by the user
27 diagnosis.type.text string Plain text representation of the concept
diagnosis.onAdmission CodeableConcept Present on admission
diagnosis.onAdmission.coding Coding Code defined by a terminology system
28 diagnosis.onAdmission.coding.system uri Identity of the terminology system
29 diagnosis.onAdmission.coding.version string Version of the system - if relevant
30 diagnosis.onAdmission.coding.code code Symbol in syntax defined by the system
31 diagnosis.onAdmission.coding.display string Representation defined by the system
32 diagnosis.onAdmission.coding.userSelected boolean If this coding was chosen directly by the user
33 diagnosis.onAdmission.text string Plain text representation of the concept
diagnosis.packageCode CodeableConcept Package billing code
diagnosis.packageCode.coding Coding Code defined by a terminology system
34 diagnosis.packageCode.coding.system uri Identity of the terminology system
35 diagnosis.packageCode.coding.version string Version of the system - if relevant
36 diagnosis.packageCode.coding.code code Symbol in syntax defined by the system
37 diagnosis.packageCode.coding.display string Representation defined by the system
38 diagnosis.packageCode.coding.userSelected boolean If this coding was chosen directly by the user
39 diagnosis.packageCode.text string Plain text representation of the concept
Row procedure
# path type required description
0 string * Subrow identifier. Must be string "procedure"
procedure Clinical procedures performed
1 procedure.sequence positiveInt Procedure instance identifier
procedure.type CodeableConcept Category of Procedure
procedure.type.coding Coding Code defined by a terminology system
2 procedure.type.coding.system uri Identity of the terminology system
3 procedure.type.coding.version string Version of the system - if relevant
4 procedure.type.coding.code code Symbol in syntax defined by the system
5 procedure.type.coding.display string Representation defined by the system
6 procedure.type.coding.userSelected boolean If this coding was chosen directly by the user
7 procedure.type.text string Plain text representation of the concept
8 procedure.date dateTime When the procedure was performed
procedure.procedure[x] Specific clinical procedure
procedure.procedureCodeableConcept CodeableConcept
procedure.procedureCodeableConcept.coding Coding Code defined by a terminology system
9 procedure.procedureCodeableConcept.coding.system uri Identity of the terminology system
10 procedure.procedureCodeableConcept.coding.version string Version of the system - if relevant
11 procedure.procedureCodeableConcept.coding.code code Symbol in syntax defined by the system
12 procedure.procedureCodeableConcept.coding.display string Representation defined by the system
13 procedure.procedureCodeableConcept.coding.userSelected boolean If this coding was chosen directly by the user
14 procedure.procedureCodeableConcept.text string Plain text representation of the concept
procedure.procedureReference Reference
15 procedure.procedureReference.reference string Literal reference, Relative, internal or absolute URL
16 procedure.procedureReference.type uri Type the reference refers to (e.g. "Patient")
procedure.procedureReference.identifier Identifier Logical reference, when literal reference is not known
17 procedure.procedureReference.identifier.use code usual | official | temp | secondary | old (If known)
procedure.procedureReference.identifier.type CodeableConcept Description of identifier
procedure.procedureReference.identifier.type.coding Coding Code defined by a terminology system
18 procedure.procedureReference.identifier.type.coding.system uri Identity of the terminology system
19 procedure.procedureReference.identifier.type.coding.version string Version of the system - if relevant
20 procedure.procedureReference.identifier.type.coding.code code Symbol in syntax defined by the system
21 procedure.procedureReference.identifier.type.coding.display string Representation defined by the system
22 procedure.procedureReference.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
23 procedure.procedureReference.identifier.type.text string Plain text representation of the concept
24 procedure.procedureReference.identifier.system uri The namespace for the identifier value
25 procedure.procedureReference.identifier.value string The value that is unique
procedure.procedureReference.identifier.period Period Time period when id is/was valid for use
26 procedure.procedureReference.identifier.period.start dateTime Starting time with inclusive boundary
27 procedure.procedureReference.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
28 procedure.procedureReference.display string Text alternative for the resource
procedure.udi Reference Unique device identifier
29 procedure.udi.reference string Literal reference, Relative, internal or absolute URL
30 procedure.udi.type uri Type the reference refers to (e.g. "Patient")
procedure.udi.identifier Identifier Logical reference, when literal reference is not known
31 procedure.udi.identifier.use code usual | official | temp | secondary | old (If known)
procedure.udi.identifier.type CodeableConcept Description of identifier
procedure.udi.identifier.type.coding Coding Code defined by a terminology system
32 procedure.udi.identifier.type.coding.system uri Identity of the terminology system
33 procedure.udi.identifier.type.coding.version string Version of the system - if relevant
34 procedure.udi.identifier.type.coding.code code Symbol in syntax defined by the system
35 procedure.udi.identifier.type.coding.display string Representation defined by the system
36 procedure.udi.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
37 procedure.udi.identifier.type.text string Plain text representation of the concept
38 procedure.udi.identifier.system uri The namespace for the identifier value
39 procedure.udi.identifier.value string The value that is unique
procedure.udi.identifier.period Period Time period when id is/was valid for use
40 procedure.udi.identifier.period.start dateTime Starting time with inclusive boundary
41 procedure.udi.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
42 procedure.udi.display string Text alternative for the resource
Row insurance
# path type required description
0 string * Subrow identifier. Must be string "insurance"
insurance Patient insurance information
1 insurance.sequence positiveInt Insurance instance identifier
2 insurance.focal boolean Coverage to be used for adjudication
insurance.identifier Identifier Pre-assigned Claim number
3 insurance.identifier.use code usual | official | temp | secondary | old (If known)
insurance.identifier.type CodeableConcept Description of identifier
insurance.identifier.type.coding Coding Code defined by a terminology system
4 insurance.identifier.type.coding.system uri Identity of the terminology system
5 insurance.identifier.type.coding.version string Version of the system - if relevant
6 insurance.identifier.type.coding.code code Symbol in syntax defined by the system
7 insurance.identifier.type.coding.display string Representation defined by the system
8 insurance.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
9 insurance.identifier.type.text string Plain text representation of the concept
10 insurance.identifier.system uri The namespace for the identifier value
11 insurance.identifier.value string The value that is unique
insurance.identifier.period Period Time period when id is/was valid for use
12 insurance.identifier.period.start dateTime Starting time with inclusive boundary
13 insurance.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
insurance.coverage Reference Insurance information
14 insurance.coverage.reference string Literal reference, Relative, internal or absolute URL
15 insurance.coverage.type uri Type the reference refers to (e.g. "Patient")
insurance.coverage.identifier Identifier Logical reference, when literal reference is not known
16 insurance.coverage.identifier.use code usual | official | temp | secondary | old (If known)
insurance.coverage.identifier.type CodeableConcept Description of identifier
insurance.coverage.identifier.type.coding Coding Code defined by a terminology system
17 insurance.coverage.identifier.type.coding.system uri Identity of the terminology system
18 insurance.coverage.identifier.type.coding.version string Version of the system - if relevant
19 insurance.coverage.identifier.type.coding.code code Symbol in syntax defined by the system
20 insurance.coverage.identifier.type.coding.display string Representation defined by the system
21 insurance.coverage.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
22 insurance.coverage.identifier.type.text string Plain text representation of the concept
23 insurance.coverage.identifier.system uri The namespace for the identifier value
24 insurance.coverage.identifier.value string The value that is unique
insurance.coverage.identifier.period Period Time period when id is/was valid for use
25 insurance.coverage.identifier.period.start dateTime Starting time with inclusive boundary
26 insurance.coverage.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
27 insurance.coverage.display string Text alternative for the resource
28 insurance.businessArrangement string Additional provider contract number
29 insurance.preAuthRef string Prior authorization reference number
insurance.claimResponse Reference Adjudication results
30 insurance.claimResponse.reference string Literal reference, Relative, internal or absolute URL
31 insurance.claimResponse.type uri Type the reference refers to (e.g. "Patient")
insurance.claimResponse.identifier Identifier Logical reference, when literal reference is not known
32 insurance.claimResponse.identifier.use code usual | official | temp | secondary | old (If known)
insurance.claimResponse.identifier.type CodeableConcept Description of identifier
insurance.claimResponse.identifier.type.coding Coding Code defined by a terminology system
33 insurance.claimResponse.identifier.type.coding.system uri Identity of the terminology system
34 insurance.claimResponse.identifier.type.coding.version string Version of the system - if relevant
35 insurance.claimResponse.identifier.type.coding.code code Symbol in syntax defined by the system
36 insurance.claimResponse.identifier.type.coding.display string Representation defined by the system
37 insurance.claimResponse.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
38 insurance.claimResponse.identifier.type.text string Plain text representation of the concept
39 insurance.claimResponse.identifier.system uri The namespace for the identifier value
40 insurance.claimResponse.identifier.value string The value that is unique
insurance.claimResponse.identifier.period Period Time period when id is/was valid for use
41 insurance.claimResponse.identifier.period.start dateTime Starting time with inclusive boundary
42 insurance.claimResponse.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
43 insurance.claimResponse.display string Text alternative for the resource
Row item
# path type required description
0 string * Subrow identifier. Must be string "item"
item Product or service provided
1 item.sequence positiveInt Item instance identifier
2 item.careTeamSequence positiveInt Applicable careTeam members
3 item.diagnosisSequence positiveInt Applicable diagnoses
4 item.procedureSequence positiveInt Applicable procedures
5 item.informationSequence positiveInt Applicable exception and supporting information
item.revenue CodeableConcept Revenue or cost center code
item.revenue.coding Coding Code defined by a terminology system
6 item.revenue.coding.system uri Identity of the terminology system
7 item.revenue.coding.version string Version of the system - if relevant
8 item.revenue.coding.code code Symbol in syntax defined by the system
9 item.revenue.coding.display string Representation defined by the system
10 item.revenue.coding.userSelected boolean If this coding was chosen directly by the user
11 item.revenue.text string Plain text representation of the concept
item.category CodeableConcept Benefit classification
item.category.coding Coding Code defined by a terminology system
12 item.category.coding.system uri Identity of the terminology system
13 item.category.coding.version string Version of the system - if relevant
14 item.category.coding.code code Symbol in syntax defined by the system
15 item.category.coding.display string Representation defined by the system
16 item.category.coding.userSelected boolean If this coding was chosen directly by the user
17 item.category.text string Plain text representation of the concept
item.productOrService CodeableConcept Billing, service, product, or drug code
item.productOrService.coding Coding Code defined by a terminology system
18 item.productOrService.coding.system uri Identity of the terminology system
19 item.productOrService.coding.version string Version of the system - if relevant
20 item.productOrService.coding.code code Symbol in syntax defined by the system
21 item.productOrService.coding.display string Representation defined by the system
22 item.productOrService.coding.userSelected boolean If this coding was chosen directly by the user
23 item.productOrService.text string Plain text representation of the concept
item.modifier CodeableConcept Product or service billing modifiers
item.modifier.coding Coding Code defined by a terminology system
24 item.modifier.coding.system uri Identity of the terminology system
25 item.modifier.coding.version string Version of the system - if relevant
26 item.modifier.coding.code code Symbol in syntax defined by the system
27 item.modifier.coding.display string Representation defined by the system
28 item.modifier.coding.userSelected boolean If this coding was chosen directly by the user
29 item.modifier.text string Plain text representation of the concept
item.programCode CodeableConcept Program the product or service is provided under
item.programCode.coding Coding Code defined by a terminology system
30 item.programCode.coding.system uri Identity of the terminology system
31 item.programCode.coding.version string Version of the system - if relevant
32 item.programCode.coding.code code Symbol in syntax defined by the system
33 item.programCode.coding.display string Representation defined by the system
34 item.programCode.coding.userSelected boolean If this coding was chosen directly by the user
35 item.programCode.text string Plain text representation of the concept
item.serviced[x] Date or dates of service or product delivery
36 item.servicedDate date
item.servicedPeriod Period
37 item.servicedPeriod.start dateTime Starting time with inclusive boundary
38 item.servicedPeriod.end dateTime End time with inclusive boundary, if not ongoing
item.location[x] Place of service or where product was supplied
item.locationCodeableConcept CodeableConcept
item.locationCodeableConcept.coding Coding Code defined by a terminology system
39 item.locationCodeableConcept.coding.system uri Identity of the terminology system
40 item.locationCodeableConcept.coding.version string Version of the system - if relevant
41 item.locationCodeableConcept.coding.code code Symbol in syntax defined by the system
42 item.locationCodeableConcept.coding.display string Representation defined by the system
43 item.locationCodeableConcept.coding.userSelected boolean If this coding was chosen directly by the user
44 item.locationCodeableConcept.text string Plain text representation of the concept
item.locationAddress Address
45 item.locationAddress.use code home | work | temp | old | billing - purpose of this address
46 item.locationAddress.type code postal | physical | both
47 item.locationAddress.text string Text representation of the address
48 item.locationAddress.line string Street name, number, direction & P.O. Box etc.
49 item.locationAddress.city string Name of city, town etc.
50 item.locationAddress.district string District name (aka county)
51 item.locationAddress.state string Sub-unit of country (abbreviations ok)
52 item.locationAddress.postalCode string Postal code for area
53 item.locationAddress.country string Country (e.g. can be ISO 3166 2 or 3 letter code)
item.locationAddress.period Period Time period when address was/is in use
54 item.locationAddress.period.start dateTime Starting time with inclusive boundary
55 item.locationAddress.period.end dateTime End time with inclusive boundary, if not ongoing
item.locationReference Reference
56 item.locationReference.reference string Literal reference, Relative, internal or absolute URL
57 item.locationReference.type uri Type the reference refers to (e.g. "Patient")
item.locationReference.identifier Identifier Logical reference, when literal reference is not known
58 item.locationReference.identifier.use code usual | official | temp | secondary | old (If known)
item.locationReference.identifier.type CodeableConcept Description of identifier
item.locationReference.identifier.type.coding Coding Code defined by a terminology system
59 item.locationReference.identifier.type.coding.system uri Identity of the terminology system
60 item.locationReference.identifier.type.coding.version string Version of the system - if relevant
61 item.locationReference.identifier.type.coding.code code Symbol in syntax defined by the system
62 item.locationReference.identifier.type.coding.display string Representation defined by the system
63 item.locationReference.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
64 item.locationReference.identifier.type.text string Plain text representation of the concept
65 item.locationReference.identifier.system uri The namespace for the identifier value
66 item.locationReference.identifier.value string The value that is unique
item.locationReference.identifier.period Period Time period when id is/was valid for use
67 item.locationReference.identifier.period.start dateTime Starting time with inclusive boundary
68 item.locationReference.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
69 item.locationReference.display string Text alternative for the resource
item.quantity Quantity Count of products or services
70 item.quantity.value decimal Numerical value (with implicit precision)
71 item.quantity.unit string Unit representation
72 item.quantity.system uri System that defines coded unit form
73 item.quantity.code code Coded form of the unit
item.unitPrice Money Fee, charge or cost per item
74 item.unitPrice.value decimal Numerical value (with implicit precision)
75 item.unitPrice.currency code ISO 4217 Currency Code
76 item.factor decimal Price scaling factor
item.net Money Total item cost
77 item.net.value decimal Numerical value (with implicit precision)
78 item.net.currency code ISO 4217 Currency Code
item.udi Reference Unique device identifier
79 item.udi.reference string Literal reference, Relative, internal or absolute URL
80 item.udi.type uri Type the reference refers to (e.g. "Patient")
item.udi.identifier Identifier Logical reference, when literal reference is not known
81 item.udi.identifier.use code usual | official | temp | secondary | old (If known)
item.udi.identifier.type CodeableConcept Description of identifier
item.udi.identifier.type.coding Coding Code defined by a terminology system
82 item.udi.identifier.type.coding.system uri Identity of the terminology system
83 item.udi.identifier.type.coding.version string Version of the system - if relevant
84 item.udi.identifier.type.coding.code code Symbol in syntax defined by the system
85 item.udi.identifier.type.coding.display string Representation defined by the system
86 item.udi.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
87 item.udi.identifier.type.text string Plain text representation of the concept
88 item.udi.identifier.system uri The namespace for the identifier value
89 item.udi.identifier.value string The value that is unique
item.udi.identifier.period Period Time period when id is/was valid for use
90 item.udi.identifier.period.start dateTime Starting time with inclusive boundary
91 item.udi.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
92 item.udi.display string Text alternative for the resource
item.bodySite CodeableConcept Anatomical location
item.bodySite.coding Coding Code defined by a terminology system
93 item.bodySite.coding.system uri Identity of the terminology system
94 item.bodySite.coding.version string Version of the system - if relevant
95 item.bodySite.coding.code code Symbol in syntax defined by the system
96 item.bodySite.coding.display string Representation defined by the system
97 item.bodySite.coding.userSelected boolean If this coding was chosen directly by the user
98 item.bodySite.text string Plain text representation of the concept
item.subSite CodeableConcept Anatomical sub-location
item.subSite.coding Coding Code defined by a terminology system
99 item.subSite.coding.system uri Identity of the terminology system
100 item.subSite.coding.version string Version of the system - if relevant
101 item.subSite.coding.code code Symbol in syntax defined by the system
102 item.subSite.coding.display string Representation defined by the system
103 item.subSite.coding.userSelected boolean If this coding was chosen directly by the user
104 item.subSite.text string Plain text representation of the concept
item.encounter Reference Encounters related to this billed item
105 item.encounter.reference string Literal reference, Relative, internal or absolute URL
106 item.encounter.type uri Type the reference refers to (e.g. "Patient")
item.encounter.identifier Identifier Logical reference, when literal reference is not known
107 item.encounter.identifier.use code usual | official | temp | secondary | old (If known)
item.encounter.identifier.type CodeableConcept Description of identifier
item.encounter.identifier.type.coding Coding Code defined by a terminology system
108 item.encounter.identifier.type.coding.system uri Identity of the terminology system
109 item.encounter.identifier.type.coding.version string Version of the system - if relevant
110 item.encounter.identifier.type.coding.code code Symbol in syntax defined by the system
111 item.encounter.identifier.type.coding.display string Representation defined by the system
112 item.encounter.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
113 item.encounter.identifier.type.text string Plain text representation of the concept
114 item.encounter.identifier.system uri The namespace for the identifier value
115 item.encounter.identifier.value string The value that is unique
item.encounter.identifier.period Period Time period when id is/was valid for use
116 item.encounter.identifier.period.start dateTime Starting time with inclusive boundary
117 item.encounter.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
118 item.encounter.display string Text alternative for the resource
item.detail Product or service provided
119 item.detail.sequence positiveInt Item instance identifier
item.detail.revenue CodeableConcept Revenue or cost center code
item.detail.revenue.coding Coding Code defined by a terminology system
120 item.detail.revenue.coding.system uri Identity of the terminology system
121 item.detail.revenue.coding.version string Version of the system - if relevant
122 item.detail.revenue.coding.code code Symbol in syntax defined by the system
123 item.detail.revenue.coding.display string Representation defined by the system
124 item.detail.revenue.coding.userSelected boolean If this coding was chosen directly by the user
125 item.detail.revenue.text string Plain text representation of the concept
item.detail.category CodeableConcept Benefit classification
item.detail.category.coding Coding Code defined by a terminology system
126 item.detail.category.coding.system uri Identity of the terminology system
127 item.detail.category.coding.version string Version of the system - if relevant
128 item.detail.category.coding.code code Symbol in syntax defined by the system
129 item.detail.category.coding.display string Representation defined by the system
130 item.detail.category.coding.userSelected boolean If this coding was chosen directly by the user
131 item.detail.category.text string Plain text representation of the concept
item.detail.productOrService CodeableConcept Billing, service, product, or drug code
item.detail.productOrService.coding Coding Code defined by a terminology system
132 item.detail.productOrService.coding.system uri Identity of the terminology system
133 item.detail.productOrService.coding.version string Version of the system - if relevant
134 item.detail.productOrService.coding.code code Symbol in syntax defined by the system
135 item.detail.productOrService.coding.display string Representation defined by the system
136 item.detail.productOrService.coding.userSelected boolean If this coding was chosen directly by the user
137 item.detail.productOrService.text string Plain text representation of the concept
item.detail.modifier CodeableConcept Service/Product billing modifiers
item.detail.modifier.coding Coding Code defined by a terminology system
138 item.detail.modifier.coding.system uri Identity of the terminology system
139 item.detail.modifier.coding.version string Version of the system - if relevant
140 item.detail.modifier.coding.code code Symbol in syntax defined by the system
141 item.detail.modifier.coding.display string Representation defined by the system
142 item.detail.modifier.coding.userSelected boolean If this coding was chosen directly by the user
143 item.detail.modifier.text string Plain text representation of the concept
item.detail.programCode CodeableConcept Program the product or service is provided under
item.detail.programCode.coding Coding Code defined by a terminology system
144 item.detail.programCode.coding.system uri Identity of the terminology system
145 item.detail.programCode.coding.version string Version of the system - if relevant
146 item.detail.programCode.coding.code code Symbol in syntax defined by the system
147 item.detail.programCode.coding.display string Representation defined by the system
148 item.detail.programCode.coding.userSelected boolean If this coding was chosen directly by the user
149 item.detail.programCode.text string Plain text representation of the concept
item.detail.quantity Quantity Count of products or services
150 item.detail.quantity.value decimal Numerical value (with implicit precision)
151 item.detail.quantity.unit string Unit representation
152 item.detail.quantity.system uri System that defines coded unit form
153 item.detail.quantity.code code Coded form of the unit
item.detail.unitPrice Money Fee, charge or cost per item
154 item.detail.unitPrice.value decimal Numerical value (with implicit precision)
155 item.detail.unitPrice.currency code ISO 4217 Currency Code
156 item.detail.factor decimal Price scaling factor
item.detail.net Money Total item cost
157 item.detail.net.value decimal Numerical value (with implicit precision)
158 item.detail.net.currency code ISO 4217 Currency Code
item.detail.udi Reference Unique device identifier
159 item.detail.udi.reference string Literal reference, Relative, internal or absolute URL
160 item.detail.udi.type uri Type the reference refers to (e.g. "Patient")
item.detail.udi.identifier Identifier Logical reference, when literal reference is not known
161 item.detail.udi.identifier.use code usual | official | temp | secondary | old (If known)
item.detail.udi.identifier.type CodeableConcept Description of identifier
item.detail.udi.identifier.type.coding Coding Code defined by a terminology system
162 item.detail.udi.identifier.type.coding.system uri Identity of the terminology system
163 item.detail.udi.identifier.type.coding.version string Version of the system - if relevant
164 item.detail.udi.identifier.type.coding.code code Symbol in syntax defined by the system
165 item.detail.udi.identifier.type.coding.display string Representation defined by the system
166 item.detail.udi.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
167 item.detail.udi.identifier.type.text string Plain text representation of the concept
168 item.detail.udi.identifier.system uri The namespace for the identifier value
169 item.detail.udi.identifier.value string The value that is unique
item.detail.udi.identifier.period Period Time period when id is/was valid for use
170 item.detail.udi.identifier.period.start dateTime Starting time with inclusive boundary
171 item.detail.udi.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
172 item.detail.udi.display string Text alternative for the resource
item.detail.subDetail Product or service provided
173 item.detail.subDetail.sequence positiveInt Item instance identifier
item.detail.subDetail.revenue CodeableConcept Revenue or cost center code
item.detail.subDetail.revenue.coding Coding Code defined by a terminology system
174 item.detail.subDetail.revenue.coding.system uri Identity of the terminology system
175 item.detail.subDetail.revenue.coding.version string Version of the system - if relevant
176 item.detail.subDetail.revenue.coding.code code Symbol in syntax defined by the system
177 item.detail.subDetail.revenue.coding.display string Representation defined by the system
178 item.detail.subDetail.revenue.coding.userSelected boolean If this coding was chosen directly by the user
179 item.detail.subDetail.revenue.text string Plain text representation of the concept
item.detail.subDetail.category CodeableConcept Benefit classification
item.detail.subDetail.category.coding Coding Code defined by a terminology system
180 item.detail.subDetail.category.coding.system uri Identity of the terminology system
181 item.detail.subDetail.category.coding.version string Version of the system - if relevant
182 item.detail.subDetail.category.coding.code code Symbol in syntax defined by the system
183 item.detail.subDetail.category.coding.display string Representation defined by the system
184 item.detail.subDetail.category.coding.userSelected boolean If this coding was chosen directly by the user
185 item.detail.subDetail.category.text string Plain text representation of the concept
item.detail.subDetail.productOrService CodeableConcept Billing, service, product, or drug code
item.detail.subDetail.productOrService.coding Coding Code defined by a terminology system
186 item.detail.subDetail.productOrService.coding.system uri Identity of the terminology system
187 item.detail.subDetail.productOrService.coding.version string Version of the system - if relevant
188 item.detail.subDetail.productOrService.coding.code code Symbol in syntax defined by the system
189 item.detail.subDetail.productOrService.coding.display string Representation defined by the system
190 item.detail.subDetail.productOrService.coding.userSelected boolean If this coding was chosen directly by the user
191 item.detail.subDetail.productOrService.text string Plain text representation of the concept
item.detail.subDetail.modifier CodeableConcept Service/Product billing modifiers
item.detail.subDetail.modifier.coding Coding Code defined by a terminology system
192 item.detail.subDetail.modifier.coding.system uri Identity of the terminology system
193 item.detail.subDetail.modifier.coding.version string Version of the system - if relevant
194 item.detail.subDetail.modifier.coding.code code Symbol in syntax defined by the system
195 item.detail.subDetail.modifier.coding.display string Representation defined by the system
196 item.detail.subDetail.modifier.coding.userSelected boolean If this coding was chosen directly by the user
197 item.detail.subDetail.modifier.text string Plain text representation of the concept
item.detail.subDetail.programCode CodeableConcept Program the product or service is provided under
item.detail.subDetail.programCode.coding Coding Code defined by a terminology system
198 item.detail.subDetail.programCode.coding.system uri Identity of the terminology system
199 item.detail.subDetail.programCode.coding.version string Version of the system - if relevant
200 item.detail.subDetail.programCode.coding.code code Symbol in syntax defined by the system
201 item.detail.subDetail.programCode.coding.display string Representation defined by the system
202 item.detail.subDetail.programCode.coding.userSelected boolean If this coding was chosen directly by the user
203 item.detail.subDetail.programCode.text string Plain text representation of the concept
item.detail.subDetail.quantity Quantity Count of products or services
204 item.detail.subDetail.quantity.value decimal Numerical value (with implicit precision)
205 item.detail.subDetail.quantity.unit string Unit representation
206 item.detail.subDetail.quantity.system uri System that defines coded unit form
207 item.detail.subDetail.quantity.code code Coded form of the unit
item.detail.subDetail.unitPrice Money Fee, charge or cost per item
208 item.detail.subDetail.unitPrice.value decimal Numerical value (with implicit precision)
209 item.detail.subDetail.unitPrice.currency code ISO 4217 Currency Code
210 item.detail.subDetail.factor decimal Price scaling factor
item.detail.subDetail.net Money Total item cost
211 item.detail.subDetail.net.value decimal Numerical value (with implicit precision)
212 item.detail.subDetail.net.currency code ISO 4217 Currency Code
item.detail.subDetail.udi Reference Unique device identifier
213 item.detail.subDetail.udi.reference string Literal reference, Relative, internal or absolute URL
214 item.detail.subDetail.udi.type uri Type the reference refers to (e.g. "Patient")
item.detail.subDetail.udi.identifier Identifier Logical reference, when literal reference is not known
215 item.detail.subDetail.udi.identifier.use code usual | official | temp | secondary | old (If known)
item.detail.subDetail.udi.identifier.type CodeableConcept Description of identifier
item.detail.subDetail.udi.identifier.type.coding Coding Code defined by a terminology system
216 item.detail.subDetail.udi.identifier.type.coding.system uri Identity of the terminology system
217 item.detail.subDetail.udi.identifier.type.coding.version string Version of the system - if relevant
218 item.detail.subDetail.udi.identifier.type.coding.code code Symbol in syntax defined by the system
219 item.detail.subDetail.udi.identifier.type.coding.display string Representation defined by the system
220 item.detail.subDetail.udi.identifier.type.coding.userSelected boolean If this coding was chosen directly by the user
221 item.detail.subDetail.udi.identifier.type.text string Plain text representation of the concept
222 item.detail.subDetail.udi.identifier.system uri The namespace for the identifier value
223 item.detail.subDetail.udi.identifier.value string The value that is unique
item.detail.subDetail.udi.identifier.period Period Time period when id is/was valid for use
224 item.detail.subDetail.udi.identifier.period.start dateTime Starting time with inclusive boundary
225 item.detail.subDetail.udi.identifier.period.end dateTime End time with inclusive boundary, if not ongoing
226 item.detail.subDetail.udi.display string Text alternative for the resource

Examples

Example #1
Input CSV
Claim,10,"MED-00050","active","http://terminology.hl7.org/CodeSystem/claim-type",,"institutional",,,,"https://www.cms.gov/codes/billtype",,"831","Hospital Outpatient Surgery performed in an Ambulatory ​Surgical Center",,,"claim","#patient-1",,,,,,,,,,,,,,,,"2015-10-16T00:00:00-07:00",,,,,,,,,,,,,,,,,,,,,,,,"http://www.bindb.com/bin","123456",,,"Humana Inc.","Organization/1",,,,,,,,,,,,,,,,"normal",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://terminology.hl7.org/CodeSystem/payeetype",,"provider",,,,"Organization/1",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12500,"USD"
identifier,,,,,,,,"http://CedarArmsMedicalCenter.com/claim","MED-00050",,
careTeam,1,"Practitioner/example",,,,,,,,,,,,,,,,,,,,,,,,,,
supportingInfo,1,"http://terminology.hl7.org/CodeSystem/claiminformationcategory",,"hospitalized",,,,,,,,,,,"2015-10-01T00:00:00-07:00","2015-10-05T00:00:00-07:00",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
supportingInfo,2,"http://terminology.hl7.org/CodeSystem/claiminformationcategory",,"discharge",,,,"https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE0801.pdf",,"01","Discharge to Home or Self Care",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
diagnosis,1,"http://hl7.org/fhir/sid/icd-10",,"M96.1","Postlaminectomy syndrome",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
diagnosis,2,"http://hl7.org/fhir/sid/icd-10",,"G89.4","Chronic pain syndrome",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
diagnosis,3,"http://hl7.org/fhir/sid/icd-10",,"M53.88","Other specified dorsopathies, sacral and sacrococcygeal region",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
diagnosis,4,"http://hl7.org/fhir/sid/icd-10",,"M47.816","Spondylosis without myelopathy or radiculopathy, lumbar region",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
insurance,1,true,,,,,,,,"http://CedarArmsMedicalCenter.com/claim","MED-00050",,,"#coverage-1",,,,,,,,,,,,,,,,,,,,,,,,,,,,,
item,1,1,2,,1,,,,,,,,,,,,,"http://www.ama-assn.org/go/cpt",,"62264","Surgical Procedures on the Spine and Spinal Cord",,,,,,,,,,,,,,,"2015-10-13",,,"https://www.cms.gov/medicare/coding/place-of-service-codes/place_of_service_code_set.html",,"24","Ambulatory Surgical Center",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,12500,"USD",,12500,"USD",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Resulting resource
{
  "resourceType": "Claim",
  "id": "MED-00050",
  "identifier": [
    {
      "system": "http://CedarArmsMedicalCenter.com/claim",
      "value": "MED-00050"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "institutional"
      }
    ]
  },
  "subType": {
    "coding": [
      {
        "system": "https://www.cms.gov/codes/billtype",
        "code": "831",
        "display": "Hospital Outpatient Surgery performed in an Ambulatory ​Surgical Center"
      }
    ]
  },
  "use": "claim",
  "patient": {
    "reference": "#patient-1"
  },
  "created": "2015-10-16T00:00:00-07:00",
  "insurer": {
    "identifier": {
      "system": "http://www.bindb.com/bin",
      "value": "123456"
    },
    "display": "Humana Inc."
  },
  "provider": {
    "reference": "Organization/1"
  },
  "priority": {
    "coding": [
      {
        "code": "normal"
      }
    ]
  },
  "payee": {
    "type": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/payeetype",
          "code": "provider"
        }
      ]
    },
    "party": {
      "reference": "Organization/1"
    }
  },
  "careTeam": [
    {
      "sequence": 1,
      "provider": {
        "reference": "Practitioner/example"
      }
    }
  ],
  "supportingInfo": [
    {
      "sequence": 1,
      "category": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
            "code": "hospitalized"
          }
        ]
      },
      "timingPeriod": {
        "start": "2015-10-01T00:00:00-07:00",
        "end": "2015-10-05T00:00:00-07:00"
      }
    },
    {
      "sequence": 2,
      "category": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
            "code": "discharge"
          }
        ]
      },
      "code": {
        "coding": [
          {
            "system": "https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE0801.pdf",
            "code": "01",
            "display": "Discharge to Home or Self Care"
          }
        ]
      }
    }
  ],
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/sid/icd-10",
            "code": "M96.1",
            "display": "Postlaminectomy syndrome"
          }
        ]
      }
    },
    {
      "sequence": 2,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/sid/icd-10",
            "code": "G89.4",
            "display": "Chronic pain syndrome"
          }
        ]
      }
    },
    {
      "sequence": 3,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/sid/icd-10",
            "code": "M53.88",
            "display": "Other specified dorsopathies, sacral and sacrococcygeal region"
          }
        ]
      }
    },
    {
      "sequence": 4,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/sid/icd-10",
            "code": "M47.816",
            "display": "Spondylosis without myelopathy or radiculopathy, lumbar region"
          }
        ]
      }
    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "identifier": {
        "system": "http://CedarArmsMedicalCenter.com/claim",
        "value": "MED-00050"
      },
      "coverage": {
        "reference": "#coverage-1"
      }
    }
  ],
  "item": [
    {
      "sequence": 1,
      "careTeamSequence": [
        1
      ],
      "diagnosisSequence": [
        2,
        4
      ],
      "informationSequence": [
        1
      ],
      "productOrService": {
        "coding": [
          {
            "system": "http://www.ama-assn.org/go/cpt",
            "code": "62264",
            "display": "Surgical Procedures on the Spine and Spinal Cord"
          }
        ]
      },
      "servicedDate": "2015-10-13",
      "locationCodeableConcept": {
        "coding": [
          {
            "system": "https://www.cms.gov/medicare/coding/place-of-service-codes/place_of_service_code_set.html",
            "code": "24",
            "display": "Ambulatory Surgical Center"
          }
        ]
      },
      "unitPrice": {
        "value": 12500,
        "currency": "USD"
      },
      "net": {
        "value": 12500,
        "currency": "USD"
      }
    }
  ],
  "total": {
    "value": 12500,
    "currency": "USD"
  }
}
Example #2
Input CSV
Claim,6,"960150","active","http://terminology.hl7.org/CodeSystem/claim-type",,"institutional",,,,"http://terminology.hl7.org/CodeSystem/ex-claimsubtype",,"emergency",,,,"claim","Patient/1",,,,,,,,,,,,,,,,"2014-08-16",,,,,,,,,,"http://jurisdiction.org/facilities/HOSP1234/users","UC1234",,,,"Organization/2",,,,,,,,,,,,,,"Organization/1",,,,,,,,,,,,,,,,"normal",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"provider",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://jurisdiction.org/facilities","HOSP1234",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,125,"USD"
identifier,,,,,,,,"http://happyhospital.com/claim","9612345",,
careTeam,1,"Practitioner/example",,,,,,,,,,,,,,,,,,,,,,,,,,
diagnosis,1,,,"654456",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
procedure,1,,,"primary",,,,"2014-08-16",,,"SDI9901",,,"Subcutaneous diagnostic implant",,,,,,,,,,,,,,,"Device/example",,,,,,,,,,,,,
insurance,1,true,,,,,,,,,,,,"Coverage/9876B1",,,,,,,,,,,,,,,,,,,,,,,,,,,,,
item,1,1,,,,,,,,,,,,,,,,"http://hl7.org/fhir/ex-serviceproduct",,"exam",,,,,,,,,,,,,,,,"2014-08-16",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,125,"USD",,125,"USD",,,,,,,,,,,,,,,,,,,,,,,,,,,"Encounter/example",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Resulting resource
{
  "resourceType": "Claim",
  "id": "960150",
  "identifier": [
    {
      "system": "http://happyhospital.com/claim",
      "value": "9612345"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "institutional"
      }
    ]
  },
  "subType": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/ex-claimsubtype",
        "code": "emergency"
      }
    ]
  },
  "use": "claim",
  "patient": {
    "reference": "Patient/1"
  },
  "created": "2014-08-16",
  "enterer": {
    "identifier": {
      "system": "http://jurisdiction.org/facilities/HOSP1234/users",
      "value": "UC1234"
    }
  },
  "insurer": {
    "reference": "Organization/2"
  },
  "provider": {
    "reference": "Organization/1"
  },
  "priority": {
    "coding": [
      {
        "code": "normal"
      }
    ]
  },
  "payee": {
    "type": {
      "coding": [
        {
          "code": "provider"
        }
      ]
    }
  },
  "facility": {
    "identifier": {
      "system": "http://jurisdiction.org/facilities",
      "value": "HOSP1234"
    }
  },
  "careTeam": [
    {
      "sequence": 1,
      "provider": {
        "reference": "Practitioner/example"
      }
    }
  ],
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "code": "654456"
          }
        ]
      }
    }
  ],
  "procedure": [
    {
      "sequence": 1,
      "type": [
        {
          "coding": [
            {
              "code": "primary"
            }
          ]
        }
      ],
      "date": "2014-08-16",
      "procedureCodeableConcept": {
        "coding": [
          {
            "code": "SDI9901"
          }
        ],
        "text": "Subcutaneous diagnostic implant"
      },
      "udi": [
        {
          "reference": "Device/example"
        }
      ]
    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "coverage": {
        "reference": "Coverage/9876B1"
      }
    }
  ],
  "item": [
    {
      "sequence": 1,
      "careTeamSequence": [
        1
      ],
      "productOrService": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/ex-serviceproduct",
            "code": "exam"
          }
        ]
      },
      "servicedDate": "2014-08-16",
      "unitPrice": {
        "value": 125,
        "currency": "USD"
      },
      "net": {
        "value": 125,
        "currency": "USD"
      },
      "encounter": [
        {
          "reference": "Encounter/example"
        }
      ]
    }
  ],
  "total": {
    "value": 125,
    "currency": "USD"
  }
}
Example #3
Input CSV
Claim,7,"960151","active","http://terminology.hl7.org/CodeSystem/claim-type",,"institutional",,,,,,,,,,"claim","Patient/1",,,,,,,,,,,,,,"2014-08-15","2014-08-16","2014-08-16",,,,,,,,,,"http://jurisdiction.org/facilities/HOSP1234/users","UC1234",,,,"Organization/2",,,,,,,,,,,,,,,,,,,,,,,"http://npid.org/providerid","NJ12345",,,,,,"normal",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"provider",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://jurisdiction.org/facilities","HOSP1234",,,,"2014-07-09","http://terminology.hl7.org/CodeSystem/v3-ActIncidentCode",,"SPT","Sporting Accident",,,,,"Grouse Mountain Ski Hill",,,,,,,,,,,,,,,,,,,,,,,125,"USD"
identifier,,,,,,,,"http://happyhospital.com/claim","96123451",,
careTeam,1,"Practitioner/example",,,,,,,,,,,,,,true,"http://example.org/fhir/CodeSystem/claim-careteamrole",,"primary",,,,"http://example.org/fhir/CodeSystem/provider-qualification",,"physician",,,
supportingInfo,1,"http://terminology.hl7.org/CodeSystem/claiminformationcategory",,"employmentimpacted",,,,,,,,,,,"2014-08-16","2014-08-16",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
supportingInfo,2,"http://terminology.hl7.org/CodeSystem/claiminformationcategory",,"hospitalized",,,,,,,,,,,"2014-08-15","2014-08-16",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
diagnosis,1,,,"654456",,,,,,,,,,,,,,,,,,"http://terminology.hl7.org/CodeSystem/ex-diagnosistype",,"admitting",,,,,,,,,,"http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup",,"400","Head trauma - concussion",,
insurance,1,true,,,,,,,,,,,,"Coverage/9876B1",,,,,,,,,,,,,,"BA987123","PA2014G56473",,,,,,,,,,,,,,
item,1,1,,,,,,,,,,,,,,,,"http://hl7.org/fhir/ex-serviceproduct",,"exam",,,,,,,,,,,,,,,,"2014-08-16",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,125,"USD",,125,"USD",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Resulting resource
{
  "resourceType": "Claim",
  "id": "960151",
  "identifier": [
    {
      "system": "http://happyhospital.com/claim",
      "value": "96123451"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "institutional"
      }
    ]
  },
  "use": "claim",
  "patient": {
    "reference": "Patient/1"
  },
  "billablePeriod": {
    "start": "2014-08-15",
    "end": "2014-08-16"
  },
  "created": "2014-08-16",
  "enterer": {
    "identifier": {
      "system": "http://jurisdiction.org/facilities/HOSP1234/users",
      "value": "UC1234"
    }
  },
  "insurer": {
    "reference": "Organization/2"
  },
  "provider": {
    "identifier": {
      "system": "http://npid.org/providerid",
      "value": "NJ12345"
    }
  },
  "priority": {
    "coding": [
      {
        "code": "normal"
      }
    ]
  },
  "payee": {
    "type": {
      "coding": [
        {
          "code": "provider"
        }
      ]
    }
  },
  "facility": {
    "identifier": {
      "system": "http://jurisdiction.org/facilities",
      "value": "HOSP1234"
    }
  },
  "careTeam": [
    {
      "sequence": 1,
      "provider": {
        "reference": "Practitioner/example"
      },
      "responsible": true,
      "role": {
        "coding": [
          {
            "system": "http://example.org/fhir/CodeSystem/claim-careteamrole",
            "code": "primary"
          }
        ]
      },
      "qualification": {
        "coding": [
          {
            "system": "http://example.org/fhir/CodeSystem/provider-qualification",
            "code": "physician"
          }
        ]
      }
    }
  ],
  "supportingInfo": [
    {
      "sequence": 1,
      "category": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
            "code": "employmentimpacted"
          }
        ]
      },
      "timingPeriod": {
        "start": "2014-08-16",
        "end": "2014-08-16"
      }
    },
    {
      "sequence": 2,
      "category": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
            "code": "hospitalized"
          }
        ]
      },
      "timingPeriod": {
        "start": "2014-08-15",
        "end": "2014-08-16"
      }
    }
  ],
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "code": "654456"
          }
        ]
      },
      "type": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
              "code": "admitting"
            }
          ]
        }
      ],
      "packageCode": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup",
            "code": "400",
            "display": "Head trauma - concussion"
          }
        ]
      }
    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "coverage": {
        "reference": "Coverage/9876B1"
      },
      "businessArrangement": "BA987123",
      "preAuthRef": [
        "PA2014G56473"
      ]
    }
  ],
  "accident": {
    "date": "2014-07-09",
    "type": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/v3-ActIncidentCode",
          "code": "SPT",
          "display": "Sporting Accident"
        }
      ]
    },
    "locationAddress": {
      "text": "Grouse Mountain Ski Hill"
    }
  },
  "item": [
    {
      "sequence": 1,
      "careTeamSequence": [
        1
      ],
      "productOrService": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/ex-serviceproduct",
            "code": "exam"
          }
        ]
      },
      "servicedDate": "2014-08-16",
      "unitPrice": {
        "value": 125,
        "currency": "USD"
      },
      "net": {
        "value": 125,
        "currency": "USD"
      }
    }
  ],
  "total": {
    "value": 125,
    "currency": "USD"
  }
}
Example #4
Input CSV
Claim,5,"100150","active","http://terminology.hl7.org/CodeSystem/claim-type",,"oral",,,,,,,,,,"claim","Patient/1",,,,,,,,,,,,,,,,"2014-08-16",,,,,,,,,,,,,,,"Organization/2",,,,,,,,,,,,,,"Organization/1",,,,,,,,,,,,,,,,"normal",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"provider",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
identifier,,,,,,,,"http://happyvalley.com/claim","12345",,
careTeam,1,"Practitioner/example",,,,,,,,,,,,,,,,,,,,,,,,,,
diagnosis,1,,,"123456",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
insurance,1,true,,,,,,,,"http://happyvalley.com/claim","12345",,,"Coverage/9876B1",,,,,,,,,,,,,,,,,,,,,,,,,,,,,
item,1,1,,,,,,,,,,,,,,,,,,"1200",,,,,,,,,,,,,,,,"2014-08-16",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,135.57,"USD",,135.57,"USD",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Resulting resource
{
  "resourceType": "Claim",
  "id": "100150",
  "identifier": [
    {
      "system": "http://happyvalley.com/claim",
      "value": "12345"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "oral"
      }
    ]
  },
  "use": "claim",
  "patient": {
    "reference": "Patient/1"
  },
  "created": "2014-08-16",
  "insurer": {
    "reference": "Organization/2"
  },
  "provider": {
    "reference": "Organization/1"
  },
  "priority": {
    "coding": [
      {
        "code": "normal"
      }
    ]
  },
  "payee": {
    "type": {
      "coding": [
        {
          "code": "provider"
        }
      ]
    }
  },
  "careTeam": [
    {
      "sequence": 1,
      "provider": {
        "reference": "Practitioner/example"
      }
    }
  ],
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "code": "123456"
          }
        ]
      }
    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "identifier": {
        "system": "http://happyvalley.com/claim",
        "value": "12345"
      },
      "coverage": {
        "reference": "Coverage/9876B1"
      }
    }
  ],
  "item": [
    {
      "sequence": 1,
      "careTeamSequence": [
        1
      ],
      "productOrService": {
        "coding": [
          {
            "code": "1200"
          }
        ]
      },
      "servicedDate": "2014-08-16",
      "unitPrice": {
        "value": 135.57,
        "currency": "USD"
      },
      "net": {
        "value": 135.57,
        "currency": "USD"
      }
    }
  ]
}
Example #5
Input CSV
Claim,9,"100151","active","http://terminology.hl7.org/CodeSystem/claim-type",,"oral",,,,,,,,,,"claim","Patient/1",,,,,,,,,,,,,,,,"2014-08-16",,,,,,,,,,,,,,,"Organization/2",,,,,,,,,,,,,,"Organization/1",,,,,,,,,,,,,,,,"normal",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"provider",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
identifier,,,,,,,,"http://happyvalley.com/claim","12346",,
careTeam,1,"Practitioner/example",,,,,,,,,,,,,,,,,,,,,,,,,,
supportingInfo,1,"http://terminology.hl7.org/CodeSystem/claiminformationcategory",,"missingtooth",,,,"http://terminology.hl7.org/CodeSystem/ex-tooth",,"15",,,,"2012-04-07",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://terminology.hl7.org/CodeSystem/missingtoothreason",,"e",,,
supportingInfo,2,"http://terminology.hl7.org/CodeSystem/claiminformationcategory",,"exception",,,,"http://terminology.hl7.org/CodeSystem/claim-exception",,"student",,,,,,,,"Happy Valley Community College",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
diagnosis,1,,,"123456",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
insurance,1,true,,,,,,,,,,,,"Coverage/9876B1",,,,,,,,,,,,,,,,,,,,,,,,,,,,,
item,1,1,,,,,,,,,,,,,,,,"http://example.org/fhir/oralservicecodes",,"1200",,,,,,,,,,,,,,,,"2014-08-16",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,135.57,"USD",,135.57,"USD",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
item,2,1,,,,,,,,,,,,,,,,"http://example.org/fhir/oralservicecodes",,"21211",,,,,,,,,,,,,,,,"2014-08-16",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,105,"USD",,105,"USD",,,,,,,,,,,,,,,"http://fdi.org/fhir/oraltoothcodes",,"21",,,,"http://fdi.org/fhir/oralsurfacecodes",,"L",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
item,3,1,,,,,,,,,,,,,,,,"http://example.org/fhir/oralservicecodes",,"27211",,,,,,,,,,,,,,,,"2014-08-16",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1100,"USD",,1100,"USD",,,,,,,,,,,,,,,"http://fdi.org/fhir/oraltoothcodes",,"36",,,,,,,,,,,,,,,,,,,,,,,,1,,,,,,,,,,,,,"http://example.org/fhir/oralservicecodes",,"27211",,,,,,,,,,,,,,,,,,,,1000,"USD",0.75,750,"USD",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Resulting resource
{
  "resourceType": "Claim",
  "id": "100151",
  "identifier": [
    {
      "system": "http://happyvalley.com/claim",
      "value": "12346"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "oral"
      }
    ]
  },
  "use": "claim",
  "patient": {
    "reference": "Patient/1"
  },
  "created": "2014-08-16",
  "insurer": {
    "reference": "Organization/2"
  },
  "provider": {
    "reference": "Organization/1"
  },
  "priority": {
    "coding": [
      {
        "code": "normal"
      }
    ]
  },
  "payee": {
    "type": {
      "coding": [
        {
          "code": "provider"
        }
      ]
    }
  },
  "careTeam": [
    {
      "sequence": 1,
      "provider": {
        "reference": "Practitioner/example"
      }
    }
  ],
  "supportingInfo": [
    {
      "sequence": 1,
      "category": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
            "code": "missingtooth"
          }
        ]
      },
      "code": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/ex-tooth",
            "code": "15"
          }
        ]
      },
      "timingDate": "2012-04-07",
      "reason": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/missingtoothreason",
            "code": "e"
          }
        ]
      }
    },
    {
      "sequence": 2,
      "category": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
            "code": "exception"
          }
        ]
      },
      "code": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/claim-exception",
            "code": "student"
          }
        ]
      },
      "valueString": "Happy Valley Community College"
    }
  ],
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "code": "123456"
          }
        ]
      }
    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "coverage": {
        "reference": "Coverage/9876B1"
      }
    }
  ],
  "item": [
    {
      "sequence": 1,
      "careTeamSequence": [
        1
      ],
      "productOrService": {
        "coding": [
          {
            "system": "http://example.org/fhir/oralservicecodes",
            "code": "1200"
          }
        ]
      },
      "servicedDate": "2014-08-16",
      "unitPrice": {
        "value": 135.57,
        "currency": "USD"
      },
      "net": {
        "value": 135.57,
        "currency": "USD"
      }
    },
    {
      "sequence": 2,
      "careTeamSequence": [
        1
      ],
      "productOrService": {
        "coding": [
          {
            "system": "http://example.org/fhir/oralservicecodes",
            "code": "21211"
          }
        ]
      },
      "servicedDate": "2014-08-16",
      "unitPrice": {
        "value": 105,
        "currency": "USD"
      },
      "net": {
        "value": 105,
        "currency": "USD"
      },
      "bodySite": {
        "coding": [
          {
            "system": "http://fdi.org/fhir/oraltoothcodes",
            "code": "21"
          }
        ]
      },
      "subSite": [
        {
          "coding": [
            {
              "system": "http://fdi.org/fhir/oralsurfacecodes",
              "code": "L"
            }
          ]
        }
      ]
    },
    {
      "sequence": 3,
      "careTeamSequence": [
        1
      ],
      "productOrService": {
        "coding": [
          {
            "system": "http://example.org/fhir/oralservicecodes",
            "code": "27211"
          }
        ]
      },
      "servicedDate": "2014-08-16",
      "unitPrice": {
        "value": 1100,
        "currency": "USD"
      },
      "net": {
        "value": 1100,
        "currency": "USD"
      },
      "bodySite": {
        "coding": [
          {
            "system": "http://fdi.org/fhir/oraltoothcodes",
            "code": "36"
          }
        ]
      },
      "detail": [
        {
          "sequence": 1,
          "productOrService": {
            "coding": [
              {
                "system": "http://example.org/fhir/oralservicecodes",
                "code": "27211"
              }
            ]
          },
          "unitPrice": {
            "value": 1000,
            "currency": "USD"
          },
          "factor": 0.75,
          "net": {
            "value": 750,
            "currency": "USD"
          }
        },
        {
          "sequence": 2,
          "productOrService": {
            "coding": [
              {
                "system": "http://example.org/fhir/oralservicecodes",
                "code": "lab"
              }
            ]
          },
          "unitPrice": {
            "value": 350,
            "currency": "USD"
          },
          "net": {
            "value": 350,
            "currency": "USD"
          }
        }
      ]
    }
  ]
}