PREFIX fhir: PREFIX fhirvs: PREFIX xsd: BASE start=@ AND {fhir:nodeRole [fhir:treeRoot]} # Claim, Pre-determination or Pre-authorization CLOSED { a [fhir:Claim]; fhir:nodeRole [fhir:treeRoot]?; fhir:Resource.id id?; # Logical id of this artifact fhir:Resource.meta @?; # Metadata about the resource fhir:Resource.implicitRules @?; # A set of rules under which this # content was created fhir:Resource.language @?; # Language of the resource content fhir:DomainResource.text @?; # Text summary of the resource, for # human interpretation fhir:DomainResource.contained @*; # Contained, inline Resources fhir:DomainResource.extension @*; # Additional content defined by # implementations fhir:DomainResource.modifierExtension @*; # Extensions that cannot be ignored fhir:Claim.identifier @*; # Business Identifier for claim fhir:Claim.status @ AND {fhir:value @fhirvs:fm-status}; # active | cancelled | draft | # entered-in-error fhir:Claim.type @; # Category or discipline fhir:Claim.subType @?; # More granular claim type fhir:Claim.use @ AND {fhir:value @fhirvs:claim-use}; # claim | preauthorization | # predetermination fhir:Claim.patient @; # The recipient of the products and # services fhir:Claim.billablePeriod @?; # Relevant time frame for the claim fhir:Claim.created @; # Resource creation date fhir:Claim.enterer @?; # Author of the claim fhir:Claim.insurer @?; # Target fhir:Claim.provider @; # Party responsible for the claim fhir:Claim.priority @; # Desired processing ugency fhir:Claim.fundsReserve @?; # For whom to reserve funds fhir:Claim.related @*; # Prior or corollary claims fhir:Claim.prescription @?; # Prescription authorizing services # and products fhir:Claim.originalPrescription @?; # Original prescription if # superseded by fulfiller fhir:Claim.payee @?; # Recipient of benefits payable fhir:Claim.referral @?; # Treatment referral fhir:Claim.facility @?; # Servicing facility fhir:Claim.careTeam @*; # Members of the care team fhir:Claim.supportingInfo @*; # Supporting information fhir:Claim.diagnosis @*; # Pertinent diagnosis information fhir:Claim.procedure @*; # Clinical procedures performed fhir:Claim.insurance @+; # Patient insurance information fhir:Claim.accident @?; # Details of the event fhir:Claim.item @*; # Product or service provided fhir:Claim.total @?; # Total claim cost fhir:index xsd:integer? # Relative position in a list } # Product or service provided CLOSED { fhir:Element.id string?; # Unique id for inter-element # referencing fhir:Element.extension @*; # Additional content defined by # implementations fhir:BackboneElement.modifierExtension @*; # Extensions that cannot be ignored # even if unrecognized fhir:Claim.item.sequence @; # Item instance identifier fhir:Claim.item.careTeamSequence @*; # Applicable careTeam members fhir:Claim.item.diagnosisSequence @*; # Applicable diagnoses fhir:Claim.item.procedureSequence @*; # Applicable procedures fhir:Claim.item.informationSequence @*; # Applicable exception and # supporting information fhir:Claim.item.revenue @?; # Revenue or cost center code fhir:Claim.item.category @?; # Benefit classification fhir:Claim.item.productOrService @; # Billing, service, product, or drug # code fhir:Claim.item.modifier @*; # Product or service billing # modifiers fhir:Claim.item.programCode @*; # Program the product or service is # provided under ( # Date or dates of service or # product delivery fhir:Claim.item.servicedDate @ | fhir:Claim.item.servicedPeriod @ )?; ( # Place of service or where product # was supplied fhir:Claim.item.locationCodeableConcept @ | fhir:Claim.item.locationAddress @
| fhir:Claim.item.locationReference @ )?; fhir:Claim.item.quantity @?; # Count of products or services fhir:Claim.item.unitPrice @?; # Fee, charge or cost per item fhir:Claim.item.factor @?; # Price scaling factor fhir:Claim.item.net @?; # Total item cost fhir:Claim.item.udi @*; # Unique device identifier fhir:Claim.item.bodySite @?; # Anatomical location fhir:Claim.item.subSite @*; # Anatomical sub-location fhir:Claim.item.encounter @*; # Encounters related to this billed # item fhir:Claim.item.detail @*; # Product or service provided fhir:index xsd:integer? # Relative position in a list } # Prior or corollary claims CLOSED { fhir:Element.id string?; # Unique id for inter-element # referencing fhir:Element.extension @*; # Additional content defined by # implementations fhir:BackboneElement.modifierExtension @*; # Extensions that cannot be ignored # even if unrecognized fhir:Claim.related.claim @?; # Reference to the related claim fhir:Claim.related.relationship @?; # How the reference claim is related fhir:Claim.related.reference @?; # File or case reference fhir:index xsd:integer? # Relative position in a list } # Clinical procedures performed CLOSED { fhir:Element.id string?; # Unique id for inter-element # referencing fhir:Element.extension @*; # Additional content defined by # implementations fhir:BackboneElement.modifierExtension @*; # Extensions that cannot be ignored # even if unrecognized fhir:Claim.procedure.sequence @; # Procedure instance identifier fhir:Claim.procedure.type @*; # Category of Procedure fhir:Claim.procedure.date @?; # When the procedure was performed ( # Specific clinical procedure fhir:Claim.procedure.procedureCodeableConcept @ | fhir:Claim.procedure.procedureReference @ ); fhir:Claim.procedure.udi @*; # Unique device identifier fhir:index xsd:integer? # Relative position in a list } # Pertinent diagnosis information CLOSED { fhir:Element.id string?; # Unique id for inter-element # referencing fhir:Element.extension @*; # Additional content defined by # implementations fhir:BackboneElement.modifierExtension @*; # Extensions that cannot be ignored # even if unrecognized fhir:Claim.diagnosis.sequence @; # Diagnosis instance identifier ( # Nature of illness or problem fhir:Claim.diagnosis.diagnosisCodeableConcept @ | fhir:Claim.diagnosis.diagnosisReference @ ); fhir:Claim.diagnosis.type @*; # Timing or nature of the diagnosis fhir:Claim.diagnosis.onAdmission @?; # Present on admission fhir:Claim.diagnosis.packageCode @?; # Package billing code fhir:index xsd:integer? # Relative position in a list } # Patient insurance information CLOSED { fhir:Element.id string?; # Unique id for inter-element # referencing fhir:Element.extension @*; # Additional content defined by # implementations fhir:BackboneElement.modifierExtension @*; # Extensions that cannot be ignored # even if unrecognized fhir:Claim.insurance.sequence @; # Insurance instance identifier fhir:Claim.insurance.focal @; # Coverage to be used for # adjudication fhir:Claim.insurance.identifier @?; # Pre-assigned Claim number fhir:Claim.insurance.coverage @; # Insurance information fhir:Claim.insurance.businessArrangement @?; # Additional provider contract number fhir:Claim.insurance.preAuthRef @*; # Prior authorization reference # number fhir:Claim.insurance.claimResponse @?; # Adjudication results fhir:index xsd:integer? # Relative position in a list } # Members of the care team CLOSED { fhir:Element.id string?; # Unique id for inter-element # referencing fhir:Element.extension @*; # Additional content defined by # implementations fhir:BackboneElement.modifierExtension @*; # Extensions that cannot be ignored # even if unrecognized fhir:Claim.careTeam.sequence @; # Order of care team fhir:Claim.careTeam.provider @; # Practitioner or organization fhir:Claim.careTeam.responsible @?; # Indicator of the lead practitioner fhir:Claim.careTeam.role @?; # Function within the team fhir:Claim.careTeam.qualification @?; # Practitioner credential or # specialization fhir:index xsd:integer? # Relative position in a list } # Supporting information CLOSED { fhir:Element.id string?; # Unique id for inter-element # referencing fhir:Element.extension @*; # Additional content defined by # implementations fhir:BackboneElement.modifierExtension @*; # Extensions that cannot be ignored # even if unrecognized fhir:Claim.supportingInfo.sequence @; # Information instance identifier fhir:Claim.supportingInfo.category @; # Classification of the supplied # information fhir:Claim.supportingInfo.code @?; # Type of information ( # When it occurred fhir:Claim.supportingInfo.timingDate @ | fhir:Claim.supportingInfo.timingPeriod @ )?; ( # Data to be provided fhir:Claim.supportingInfo.valueBoolean @ | fhir:Claim.supportingInfo.valueString @ | fhir:Claim.supportingInfo.valueQuantity @ | fhir:Claim.supportingInfo.valueAttachment @ | fhir:Claim.supportingInfo.valueReference @ )?; fhir:Claim.supportingInfo.reason @?; # Explanation for the information fhir:index xsd:integer? # Relative position in a list } # Recipient of benefits payable CLOSED { fhir:Element.id string?; # Unique id for inter-element # referencing fhir:Element.extension @*; # Additional content defined by # implementations fhir:BackboneElement.modifierExtension @*; # Extensions that cannot be ignored # even if unrecognized fhir:Claim.payee.type @; # Category of recipient fhir:Claim.payee.party @?; # Recipient reference fhir:index xsd:integer? # Relative position in a list } # Details of the event CLOSED { fhir:Element.id string?; # Unique id for inter-element # referencing fhir:Element.extension @*; # Additional content defined by # implementations fhir:BackboneElement.modifierExtension @*; # Extensions that cannot be ignored # even if unrecognized fhir:Claim.accident.date @; # When the incident occurred fhir:Claim.accident.type @?; # The nature of the accident ( # Where the event occurred fhir:Claim.accident.locationAddress @
| fhir:Claim.accident.locationReference @ )?; fhir:index xsd:integer? # Relative position in a list } # Product or service provided CLOSED { fhir:Element.id string?; # Unique id for inter-element # referencing fhir:Element.extension @*; # Additional content defined by # implementations fhir:BackboneElement.modifierExtension @*; # Extensions that cannot be ignored # even if unrecognized fhir:Claim.item.detail.sequence @; # Item instance identifier fhir:Claim.item.detail.revenue @?; # Revenue or cost center code fhir:Claim.item.detail.category @?; # Benefit classification fhir:Claim.item.detail.productOrService @; # Billing, service, product, or drug # code fhir:Claim.item.detail.modifier @*; # Service/Product billing modifiers fhir:Claim.item.detail.programCode @*; # Program the product or service is # provided under fhir:Claim.item.detail.quantity @?; # Count of products or services fhir:Claim.item.detail.unitPrice @?; # Fee, charge or cost per item fhir:Claim.item.detail.factor @?; # Price scaling factor fhir:Claim.item.detail.net @?; # Total item cost fhir:Claim.item.detail.udi @*; # Unique device identifier fhir:Claim.item.detail.subDetail @*; # Product or service provided fhir:index xsd:integer? # Relative position in a list } # Product or service provided CLOSED { fhir:Element.id string?; # Unique id for inter-element # referencing fhir:Element.extension @*; # Additional content defined by # implementations fhir:BackboneElement.modifierExtension @*; # Extensions that cannot be ignored # even if unrecognized fhir:Claim.item.detail.subDetail.sequence @; # Item instance identifier fhir:Claim.item.detail.subDetail.revenue @?; # Revenue or cost center code fhir:Claim.item.detail.subDetail.category @?; # Benefit classification fhir:Claim.item.detail.subDetail.productOrService @; # Billing, service, product, or drug # code fhir:Claim.item.detail.subDetail.modifier @*; # Service/Product billing modifiers fhir:Claim.item.detail.subDetail.programCode @*; # Program the product or service is # provided under fhir:Claim.item.detail.subDetail.quantity @?; # Count of products or services fhir:Claim.item.detail.subDetail.unitPrice @?; # Fee, charge or cost per item fhir:Claim.item.detail.subDetail.factor @?; # Price scaling factor fhir:Claim.item.detail.subDetail.net @?; # Total item cost fhir:Claim.item.detail.subDetail.udi @*; # Unique device identifier fhir:index xsd:integer? # Relative position in a list } #---------------------- Data Types ------------------- # Primitive Type dateTime CLOSED { fhir:Element.id string?; # xml:id (or equivalent in JSON) fhir:Element.extension @*; # Additional content defined by # implementations fhir:value dateTime?; # Primitive value for dateTime fhir:index xsd:integer? # Relative position in a list } # Primitive Type date CLOSED { fhir:Element.id string?; # xml:id (or equivalent in JSON) fhir:Element.extension @*; # Additional content defined by # implementations fhir:value date?; # Primitive value for date fhir:index xsd:integer? # Relative position in a list } # Metadata about a resource CLOSED { fhir:Element.id id?; # Unique id for inter-element # referencing fhir:Element.extension @*; # Additional content defined by # implementations fhir:Meta.versionId @?; # Version specific identifier fhir:Meta.lastUpdated @?; # When the resource version last # changed fhir:Meta.source @?; # Identifies where the resource # comes from fhir:Meta.profile @*; # Profiles this resource claims to # conform to fhir:Meta.security @*; # Security Labels applied to this # resource fhir:Meta.tag @*; # Tags applied to this resource fhir:index xsd:integer? # Relative position in a list } # Primitive Type code CLOSED { fhir:Element.id string?; # xml:id (or equivalent in JSON) fhir:Element.extension @*; # Additional content defined by # implementations fhir:value code?; # Primitive value for code fhir:index xsd:integer? # Relative position in a list } # An address expressed using postal conventions (as opposed to GPS or other location definition formats)
CLOSED { fhir:Element.id id?; # Unique id for inter-element # referencing fhir:Element.extension @*; # Additional content defined by # implementations fhir:Address.use @ AND {fhir:value @fhirvs:address-use}?; # home | work | temp | old | billing # - purpose of this address fhir:Address.type @ AND {fhir:value @fhirvs:address-type}?; # postal | physical | both fhir:Address.text @?; # Text representation of the address fhir:Address.line @*; # Street name, number, direction & # P.O. Box etc. fhir:Address.city @?; # Name of city, town etc. fhir:Address.district @?; # District name (aka county) fhir:Address.state @?; # Sub-unit of country (abbreviations # ok) fhir:Address.postalCode @?; # Postal code for area fhir:Address.country @?; # Country (e.g. can be ISO 3166 2 or # 3 letter code) fhir:Address.period @?; # Time period when address was/is in # use fhir:index xsd:integer? # Relative position in a list } # Primitive Type string CLOSED { fhir:Element.id string?; # xml:id (or equivalent in JSON) fhir:Element.extension @*; # Additional content defined by # implementations fhir:value string MAXLENGTH 1048576?; # Primitive value for string fhir:index xsd:integer? # Relative position in a list } # A reference from one resource to another CLOSED { fhir:link IRI?; fhir:Element.id id?; # Unique id for inter-element # referencing fhir:Element.extension @*; # Additional content defined by # implementations fhir:Reference.reference @?; # Literal reference, Relative, # internal or absolute URL fhir:Reference.type @?; # Type the reference refers to (e.g. # "Patient") fhir:Reference.identifier @?; # Logical reference, when literal # reference is not known fhir:Reference.display @?; # Text alternative for the resource fhir:index xsd:integer? # Relative position in a list } # Base Resource {a .+; fhir:Resource.id id?; # Logical id of this artifact fhir:Resource.meta @?; # Metadata about the resource fhir:Resource.implicitRules @?; # A set of rules under which this # content was created fhir:Resource.language @?; # Language of the resource content fhir:index xsd:integer? } # A fixed quantity (no comparator) CLOSED { fhir:Element.id id?; # Unique id for inter-element # referencing fhir:Element.extension @*; # Additional content defined by # implementations fhir:Quantity.value @?; # Numerical value (with implicit # precision) fhir:Quantity.unit @?; # Unit representation fhir:Quantity.system @?; # System that defines coded unit form fhir:Quantity.code @?; # Coded form of the unit fhir:index xsd:integer? # Relative position in a list } # Time range defined by start and end date/time CLOSED { fhir:Element.id id?; # Unique id for inter-element # referencing fhir:Element.extension @*; # Additional content defined by # implementations fhir:Period.start @?; # Starting time with inclusive # boundary fhir:Period.end @?; # End time with inclusive boundary, # if not ongoing fhir:index xsd:integer? # Relative position in a list } # A measured or measurable amount CLOSED { fhir:Element.id id?; # Unique id for inter-element # referencing fhir:Element.extension @*; # Additional content defined by # implementations fhir:Quantity.value @?; # Numerical value (with implicit # precision) fhir:Quantity.comparator @ AND {fhir:value @fhirvs:quantity-comparator}?; # < | <= | >= | > - how to # understand the value fhir:Quantity.unit @?; # Unit representation fhir:Quantity.system @?; # System that defines coded unit form fhir:Quantity.code @?; # Coded form of the unit fhir:index xsd:integer? # Relative position in a list } # Content in a format defined elsewhere CLOSED { fhir:Element.id id?; # Unique id for inter-element # referencing fhir:Element.extension @*; # Additional content defined by # implementations fhir:Attachment.contentType @ AND {fhir:value @fhirvs:mimetypes}?; # Mime type of the content, with # charset etc. fhir:Attachment.language @?; # Human language of the content # (BCP-47) fhir:Attachment.data @?; # Data inline, base64ed fhir:Attachment.url @?; # Uri where the data can be found fhir:Attachment.size @?; # Number of bytes of content (if url # provided) fhir:Attachment.hash @?; # Hash of the data (sha-1, base64ed) fhir:Attachment.title @?; # Label to display in place of the # data fhir:Attachment.creation @?; # Date attachment was first created fhir:index xsd:integer? # Relative position in a list } # Primitive Type uri CLOSED { fhir:Element.id string?; # xml:id (or equivalent in JSON) fhir:Element.extension @*; # Additional content defined by # implementations fhir:value uri?; # Primitive value for uri fhir:index xsd:integer? # Relative position in a list } # Optional Extensions Element CLOSED { fhir:Element.id id?; fhir:Element.extension @*; fhir:Extension.url uri; ( fhir:Extension.valueBase64Binary @ | fhir:Extension.valueBoolean @ | fhir:Extension.valueCanonical @ | fhir:Extension.valueCode @ | fhir:Extension.valueDate @ | fhir:Extension.valueDateTime @ | fhir:Extension.valueDecimal @ | fhir:Extension.valueId @ | fhir:Extension.valueInstant @ | fhir:Extension.valueInteger @ | fhir:Extension.valueMarkdown @ | fhir:Extension.valueOid @ | fhir:Extension.valuePositiveInt @ | fhir:Extension.valueString @ | fhir:Extension.valueTime @