Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.3 - release

Health New Zealand Te Whatu Ora Shared Care FHIR API - Local Development build (v0.4.3) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## Resource Profile: NZ SharedCare Claim

Official URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/SharedCareClaim | Version: 0.0.1
Draft as of 2025-11-25 | Computable Name: SharedCareClaim

A FHIR resource profile for NZ generic payment claims.

A FHIR resource profile for NZ generic payment claims.

Usages:

- Refer to this Profile: NZ SharedCare Claim Response
- Examples for this Profile: Claim/NzTelehealthClaimExample
- CapabilityStatements using this Profile: Shared Care FHIR Server Capability Statement

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization Constraints: hpiOrNzbnIdentifierPattern
meta | Σ | 1..1 | Meta | Metadata about the resource
source | Σ | 1..1 | uri | HPI Facility ID from where the record is sourced
tag | Σ | 1..* | Coding | Correlation-id where the record is sourced Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:traceNumber |  | 0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
extension:agreementNumber |  | 1..1 | string | Shared Care Agreement Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-agreement-number
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | Business identifier(s) for the claim
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | Σ | 1..1 | CodeableConcept | Claim type Binding: NZ Claim Types (extensible)
subType |  | 0..1 | CodeableConcept | Claim subtype Binding: NZ Claim Subtypes (extensible)
use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
patient | Σ | 1..1 | Reference(NZ Patient | Patient) | Patient with NHI
created | Σ | 1..1 | dateTime | Resource creation date
provider | Σ | 1..1 | Reference(Organization) | Legal entity who submitted the claim
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
supportingInfo |  | 0..* | BackboneElement | Additional attributes that may accompany a Claim
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
insurance | Σ | 1..1 | BackboneElement | Patient insurance information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication
coverage | Σ | 1..1 | Reference(Coverage) | Insurance information
item |  | 0..* | BackboneElement | Each individual product or service being claimed for as part of this claim
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:patientPaid |  | 0..1 | Money | Shared Care Patient Copayment URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-patient-copayment
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | S | 1..1 | positiveInt | Referred to by the ClaimResponse.item.itemSequence
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Slices for location[x] |  | 0..1 |  | Place of service or where product was supplied Slice: Unordered, Open by type:$this Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept |  |  | CodeableConcept |
locationAddress |  |  | Address |
locationReference |  |  | Reference(Location) |
location[x]:locationReference |  | 0..1 | Reference(Location) | HPI Facility
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
Claim.meta.tag | example | CommonTags `http://hl7.org/fhir/ValueSet/common-tags` From the FHIR Standard
Claim.status | required | FinancialResourceStatusCodes `http://hl7.org/fhir/ValueSet/fm-status|4.0.1` From the FHIR Standard
Claim.type | extensible | NzClaimTypes `https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-types` From this IG
Claim.subType | extensible | NzClaimSubtypes(a valid code from NZ Claim Subtype Code System) `https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-subtypes` From this IG
Claim.use | required | Use `http://hl7.org/fhir/ValueSet/claim-use|4.0.1` From the FHIR Standard
Claim.priority | example | ProcessPriorityCodes `http://hl7.org/fhir/ValueSet/process-priority` From the FHIR Standard
Claim.payee.type | example | Claim Payee Type Codes `http://hl7.org/fhir/ValueSet/payeetype` From the FHIR Standard
Claim.supportingInfo.category | example | ClaimInformationCategoryCodes `http://hl7.org/fhir/ValueSet/claim-informationcategory` From the FHIR Standard
Claim.diagnosis.diagnosis[x] | example | ICD-10Codes `http://hl7.org/fhir/ValueSet/icd-10` From the FHIR Standard
Claim.procedure.procedure[x] | example | ICD-10ProcedureCodes `http://hl7.org/fhir/ValueSet/icd-10-procedures` From the FHIR Standard
Claim.item.productOrService | example | USCLSCodes `http://hl7.org/fhir/ValueSet/service-uscls` From the FHIR Standard
Claim.item.location[x] | example | ExampleServicePlaceCodes `http://hl7.org/fhir/ValueSet/service-place` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() |
dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() |
dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Claim | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
hpiOrNzbnIdentifierPattern | error | Claim | Identifiers with system 'https://standards.digital.health.nz/ns/hpi-organisation-id', 'https://standards.digital.health.nz/ns/hpi-facility-id' or 'https://standards.digital.health.nz/ns/hpi-nzbn' must conform to the NZ HPI/NZBN identifier patterns. : %context.descendants().identifier.all( (system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')) ).exists() or %context.descendants().identifier.where( system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or system = 'https://standards.digital.health.nz/ns/hpi-facility-id' or system = 'https://standards.digital.health.nz/ns/hpi-nzbn' ).empty() |

This structure is derived from Claim

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization Constraints: hpiOrNzbnIdentifierPattern
meta |  | 1..1 | Meta | Metadata about the resource
source |  | 1..1 | uri | HPI Facility ID from where the record is sourced
tag |  | 1..* | Coding | Correlation-id where the record is sourced
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:traceNumber |  | 0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
extension:agreementNumber |  | 1..1 | string | Shared Care Agreement Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-agreement-number
identifier |  | 0..* | Identifier | Business identifier(s) for the claim
type |  | 1..1 | CodeableConcept | Claim type Binding: NZ Claim Types (extensible)
subType |  | 0..1 | CodeableConcept | Claim subtype Binding: NZ Claim Subtypes (extensible)
patient |  | 1..1 | Reference(NZ Patient | Patient) | Patient with NHI
insurer |  | 0..0 |  |
provider |  | 1..1 | Reference(Organization) | Legal entity who submitted the claim
fundsReserve |  | 0..0 |  |
prescription |  | 0..0 |  |
originalPrescription |  | 0..0 |  |
payee |  | 0..0 |  |
careTeam |  | 0..0 |  |
supportingInfo |  | 0..* | BackboneElement | Additional attributes that may accompany a Claim
diagnosis |  | 0..0 |  |
procedure |  | 0..0 |  |
insurance |  | 1..1 | BackboneElement | Patient insurance information
accident |  | 0..0 |  |
item |  | 0..* | BackboneElement | Each individual product or service being claimed for as part of this claim
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:patientPaid |  | 0..1 | Money | Shared Care Patient Copayment URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-patient-copayment
sequence | S | 1..1 | positiveInt | Referred to by the ClaimResponse.item.itemSequence
Slices for location[x] |  | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Slice: Unordered, Open by type:$this
location[x]:locationReference |  | 0..1 | Reference(Location) | HPI Facility
unitPrice |  | 0..0 |  |
net |  | 0..0 |  |
total |  | 0..0 |  |
Documentation for this format

#### Terminology Bindings (Differential)

Path | Conformance | ValueSet | URI
Claim.type | extensible | NzClaimTypes `https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-types` From this IG
Claim.subType | extensible | NzClaimSubtypes(a valid code from NZ Claim Subtype Code System) `https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-subtypes` From this IG

#### Constraints

Id | Grade | Path(s) | Details | Requirements
hpiOrNzbnIdentifierPattern | error | Claim | Identifiers with system 'https://standards.digital.health.nz/ns/hpi-organisation-id', 'https://standards.digital.health.nz/ns/hpi-facility-id' or 'https://standards.digital.health.nz/ns/hpi-nzbn' must conform to the NZ HPI/NZBN identifier patterns. : %context.descendants().identifier.all( (system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')) ).exists() or %context.descendants().identifier.where( system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or system = 'https://standards.digital.health.nz/ns/hpi-facility-id' or system = 'https://standards.digital.health.nz/ns/hpi-nzbn' ).empty() |

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization Constraints: hpiOrNzbnIdentifierPattern
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 1..1 | Meta | Metadata about the resource
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
versionId | Σ | 0..1 | id | Version specific identifier
lastUpdated | Σ | 0..1 | instant | When the resource version last changed
source | Σ | 1..1 | uri | HPI Facility ID from where the record is sourced
profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag | Σ | 1..* | Coding | Correlation-id where the record is sourced Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:traceNumber |  | 0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
extension:agreementNumber |  | 1..1 | string | Shared Care Agreement Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-agreement-number
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | Business identifier(s) for the claim
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | Σ | 1..1 | CodeableConcept | Claim type Binding: NZ Claim Types (extensible)
subType |  | 0..1 | CodeableConcept | Claim subtype Binding: NZ Claim Subtypes (extensible)
use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
patient | Σ | 1..1 | Reference(NZ Patient | Patient) | Patient with NHI
billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim
created | Σ | 1..1 | dateTime | Resource creation date
enterer |  | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim
provider | Σ | 1..1 | Reference(Organization) | Legal entity who submitted the claim
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
related |  | 0..* | BackboneElement | Prior or corollary claims
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
claim |  | 0..1 | Reference(Claim) | Reference to the related claim
relationship |  | 0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference |  | 0..1 | Identifier | File or case reference
referral |  | 0..1 | Reference(ServiceRequest) | Treatment referral
facility |  | 0..1 | Reference(Location) | Servicing facility
supportingInfo |  | 0..* | BackboneElement | Additional attributes that may accompany a Claim
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
code |  | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
value[x] |  | 0..1 |  | Data to be provided
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
insurance | Σ | 1..1 | BackboneElement | Patient insurance information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication
identifier |  | 0..1 | Identifier | Pre-assigned Claim number
coverage | Σ | 1..1 | Reference(Coverage) | Insurance information
businessArrangement |  | 0..1 | string | Additional provider contract number
preAuthRef |  | 0..* | string | Prior authorization reference number
claimResponse |  | 0..1 | Reference(ClaimResponse) | Adjudication results
item |  | 0..* | BackboneElement | Each individual product or service being claimed for as part of this claim
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:patientPaid |  | 0..1 | Money | Shared Care Patient Copayment URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-patient-copayment
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | S | 1..1 | positiveInt | Referred to by the ClaimResponse.item.itemSequence
careTeamSequence |  | 0..* | positiveInt | Applicable careTeam members
diagnosisSequence |  | 0..* | positiveInt | Applicable diagnoses
procedureSequence |  | 0..* | positiveInt | Applicable procedures
informationSequence |  | 0..* | positiveInt | Applicable exception and supporting information
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
Slices for location[x] |  | 0..1 |  | Place of service or where product was supplied Slice: Unordered, Open by type:$this Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept |  |  | CodeableConcept |
locationAddress |  |  | Address |
locationReference |  |  | Reference(Location) |
location[x]:locationReference |  | 0..1 | Reference(Location) | HPI Facility
quantity |  | 0..1 | SimpleQuantity | Count of products or services
factor |  | 0..1 | decimal | Price scaling factor
udi |  | 0..* | Reference(Device) | Unique device identifier
bodySite |  | 0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite |  | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
encounter |  | 0..* | Reference(Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity |  | 0..1 | SimpleQuantity | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
subDetail |  | 0..* | BackboneElement | Product or service provided
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity |  | 0..1 | SimpleQuantity | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
Claim.meta.security | extensible | All Security Labels `http://hl7.org/fhir/ValueSet/security-labels` From the FHIR Standard
Claim.meta.tag | example | CommonTags `http://hl7.org/fhir/ValueSet/common-tags` From the FHIR Standard
Claim.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` From the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
Claim.status | required | FinancialResourceStatusCodes `http://hl7.org/fhir/ValueSet/fm-status|4.0.1` From the FHIR Standard
Claim.type | extensible | NzClaimTypes `https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-types` From this IG
Claim.subType | extensible | NzClaimSubtypes(a valid code from NZ Claim Subtype Code System) `https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-subtypes` From this IG
Claim.use | required | Use `http://hl7.org/fhir/ValueSet/claim-use|4.0.1` From the FHIR Standard
Claim.priority | example | ProcessPriorityCodes `http://hl7.org/fhir/ValueSet/process-priority` From the FHIR Standard
Claim.related.relationship | example | ExampleRelatedClaimRelationshipCodes `http://hl7.org/fhir/ValueSet/related-claim-relationship` From the FHIR Standard
Claim.payee.type | example | Claim Payee Type Codes `http://hl7.org/fhir/ValueSet/payeetype` From the FHIR Standard
Claim.careTeam.role | example | ClaimCareTeamRoleCodes `http://hl7.org/fhir/ValueSet/claim-careteamrole` From the FHIR Standard
Claim.careTeam.qualification | example | ExampleProviderQualificationCodes `http://hl7.org/fhir/ValueSet/provider-qualification` From the FHIR Standard
Claim.supportingInfo.category | example | ClaimInformationCategoryCodes `http://hl7.org/fhir/ValueSet/claim-informationcategory` From the FHIR Standard
Claim.supportingInfo.code | example | ExceptionCodes `http://hl7.org/fhir/ValueSet/claim-exception` From the FHIR Standard
Claim.supportingInfo.reason | example | MissingToothReasonCodes `http://hl7.org/fhir/ValueSet/missing-tooth-reason` From the FHIR Standard
Claim.diagnosis.diagnosis[x] | example | ICD-10Codes `http://hl7.org/fhir/ValueSet/icd-10` From the FHIR Standard
Claim.diagnosis.type | example | ExampleDiagnosisTypeCodes `http://hl7.org/fhir/ValueSet/ex-diagnosistype` From the FHIR Standard
Claim.diagnosis.onAdmission | example | ExampleDiagnosisOnAdmissionCodes `http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission` From the FHIR Standard
Claim.diagnosis.packageCode | example | ExampleDiagnosisRelatedGroupCodes `http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup` From the FHIR Standard
Claim.procedure.type | example | ExampleProcedureTypeCodes `http://hl7.org/fhir/ValueSet/ex-procedure-type` From the FHIR Standard
Claim.procedure.procedure[x] | example | ICD-10ProcedureCodes `http://hl7.org/fhir/ValueSet/icd-10-procedures` From the FHIR Standard
Claim.accident.type | extensible | ActIncidentCode `http://terminology.hl7.org/ValueSet/v3-ActIncidentCode`
Claim.item.revenue | example | ExampleRevenueCenterCodes `http://hl7.org/fhir/ValueSet/ex-revenue-center` From the FHIR Standard
Claim.item.category | example | BenefitCategoryCodes `http://hl7.org/fhir/ValueSet/ex-benefitcategory` From the FHIR Standard
Claim.item.productOrService | example | USCLSCodes `http://hl7.org/fhir/ValueSet/service-uscls` From the FHIR Standard
Claim.item.modifier | example | ModifierTypeCodes `http://hl7.org/fhir/ValueSet/claim-modifiers` From the FHIR Standard
Claim.item.programCode | example | ExampleProgramReasonCodes `http://hl7.org/fhir/ValueSet/ex-program-code` From the FHIR Standard
Claim.item.location[x] | example | ExampleServicePlaceCodes `http://hl7.org/fhir/ValueSet/service-place` From the FHIR Standard
Claim.item.bodySite | example | OralSiteCodes `http://hl7.org/fhir/ValueSet/tooth` From the FHIR Standard
Claim.item.subSite | example | SurfaceCodes `http://hl7.org/fhir/ValueSet/surface` From the FHIR Standard
Claim.item.detail.revenue | example | ExampleRevenueCenterCodes `http://hl7.org/fhir/ValueSet/ex-revenue-center` From the FHIR Standard
Claim.item.detail.category | example | BenefitCategoryCodes `http://hl7.org/fhir/ValueSet/ex-benefitcategory` From the FHIR Standard
Claim.item.detail.productOrService | example | USCLSCodes `http://hl7.org/fhir/ValueSet/service-uscls` From the FHIR Standard
Claim.item.detail.modifier | example | ModifierTypeCodes `http://hl7.org/fhir/ValueSet/claim-modifiers` From the FHIR Standard
Claim.item.detail.programCode | example | ExampleProgramReasonCodes `http://hl7.org/fhir/ValueSet/ex-program-code` From the FHIR Standard
Claim.item.detail.subDetail.revenue | example | ExampleRevenueCenterCodes `http://hl7.org/fhir/ValueSet/ex-revenue-center` From the FHIR Standard
Claim.item.detail.subDetail.category | example | BenefitCategoryCodes `http://hl7.org/fhir/ValueSet/ex-benefitcategory` From the FHIR Standard
Claim.item.detail.subDetail.productOrService | example | USCLSCodes `http://hl7.org/fhir/ValueSet/service-uscls` From the FHIR Standard
Claim.item.detail.subDetail.modifier | example | ModifierTypeCodes `http://hl7.org/fhir/ValueSet/claim-modifiers` From the FHIR Standard
Claim.item.detail.subDetail.programCode | example | ExampleProgramReasonCodes `http://hl7.org/fhir/ValueSet/ex-program-code` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() |
dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() |
dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Claim | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
hpiOrNzbnIdentifierPattern | error | Claim | Identifiers with system 'https://standards.digital.health.nz/ns/hpi-organisation-id', 'https://standards.digital.health.nz/ns/hpi-facility-id' or 'https://standards.digital.health.nz/ns/hpi-nzbn' must conform to the NZ HPI/NZBN identifier patterns. : %context.descendants().identifier.all( (system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')) ).exists() or %context.descendants().identifier.where( system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or system = 'https://standards.digital.health.nz/ns/hpi-facility-id' or system = 'https://standards.digital.health.nz/ns/hpi-nzbn' ).empty() |

This structure is derived from Claim

Summary

Mandatory: 5 elements
Must-Support: 1 element
Prohibited: 12 elements

Structures

This structure refers to these other structures:

- NZ Patient (http://hl7.org.nz/fhir/StructureDefinition/NzPatient)

Extensions

This structure refers to these extensions:

- https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
- https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-agreement-number
- https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-patient-copayment

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Claim.item.location[x]

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization Constraints: hpiOrNzbnIdentifierPattern
meta | Σ | 1..1 | Meta | Metadata about the resource
source | Σ | 1..1 | uri | HPI Facility ID from where the record is sourced
tag | Σ | 1..* | Coding | Correlation-id where the record is sourced Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:traceNumber |  | 0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
extension:agreementNumber |  | 1..1 | string | Shared Care Agreement Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-agreement-number
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | Business identifier(s) for the claim
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | Σ | 1..1 | CodeableConcept | Claim type Binding: NZ Claim Types (extensible)
subType |  | 0..1 | CodeableConcept | Claim subtype Binding: NZ Claim Subtypes (extensible)
use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
patient | Σ | 1..1 | Reference(NZ Patient | Patient) | Patient with NHI
created | Σ | 1..1 | dateTime | Resource creation date
provider | Σ | 1..1 | Reference(Organization) | Legal entity who submitted the claim
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
supportingInfo |  | 0..* | BackboneElement | Additional attributes that may accompany a Claim
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
insurance | Σ | 1..1 | BackboneElement | Patient insurance information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication
coverage | Σ | 1..1 | Reference(Coverage) | Insurance information
item |  | 0..* | BackboneElement | Each individual product or service being claimed for as part of this claim
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:patientPaid |  | 0..1 | Money | Shared Care Patient Copayment URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-patient-copayment
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | S | 1..1 | positiveInt | Referred to by the ClaimResponse.item.itemSequence
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Slices for location[x] |  | 0..1 |  | Place of service or where product was supplied Slice: Unordered, Open by type:$this Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept |  |  | CodeableConcept |
locationAddress |  |  | Address |
locationReference |  |  | Reference(Location) |
location[x]:locationReference |  | 0..1 | Reference(Location) | HPI Facility
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
Claim.meta.tag | example | CommonTags `http://hl7.org/fhir/ValueSet/common-tags` From the FHIR Standard
Claim.status | required | FinancialResourceStatusCodes `http://hl7.org/fhir/ValueSet/fm-status|4.0.1` From the FHIR Standard
Claim.type | extensible | NzClaimTypes `https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-types` From this IG
Claim.subType | extensible | NzClaimSubtypes(a valid code from NZ Claim Subtype Code System) `https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-subtypes` From this IG
Claim.use | required | Use `http://hl7.org/fhir/ValueSet/claim-use|4.0.1` From the FHIR Standard
Claim.priority | example | ProcessPriorityCodes `http://hl7.org/fhir/ValueSet/process-priority` From the FHIR Standard
Claim.payee.type | example | Claim Payee Type Codes `http://hl7.org/fhir/ValueSet/payeetype` From the FHIR Standard
Claim.supportingInfo.category | example | ClaimInformationCategoryCodes `http://hl7.org/fhir/ValueSet/claim-informationcategory` From the FHIR Standard
Claim.diagnosis.diagnosis[x] | example | ICD-10Codes `http://hl7.org/fhir/ValueSet/icd-10` From the FHIR Standard
Claim.procedure.procedure[x] | example | ICD-10ProcedureCodes `http://hl7.org/fhir/ValueSet/icd-10-procedures` From the FHIR Standard
Claim.item.productOrService | example | USCLSCodes `http://hl7.org/fhir/ValueSet/service-uscls` From the FHIR Standard
Claim.item.location[x] | example | ExampleServicePlaceCodes `http://hl7.org/fhir/ValueSet/service-place` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() |
dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() |
dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Claim | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
hpiOrNzbnIdentifierPattern | error | Claim | Identifiers with system 'https://standards.digital.health.nz/ns/hpi-organisation-id', 'https://standards.digital.health.nz/ns/hpi-facility-id' or 'https://standards.digital.health.nz/ns/hpi-nzbn' must conform to the NZ HPI/NZBN identifier patterns. : %context.descendants().identifier.all( (system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')) ).exists() or %context.descendants().identifier.where( system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or system = 'https://standards.digital.health.nz/ns/hpi-facility-id' or system = 'https://standards.digital.health.nz/ns/hpi-nzbn' ).empty() |

Differential View

This structure is derived from Claim

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization Constraints: hpiOrNzbnIdentifierPattern
meta |  | 1..1 | Meta | Metadata about the resource
source |  | 1..1 | uri | HPI Facility ID from where the record is sourced
tag |  | 1..* | Coding | Correlation-id where the record is sourced
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:traceNumber |  | 0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
extension:agreementNumber |  | 1..1 | string | Shared Care Agreement Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-agreement-number
identifier |  | 0..* | Identifier | Business identifier(s) for the claim
type |  | 1..1 | CodeableConcept | Claim type Binding: NZ Claim Types (extensible)
subType |  | 0..1 | CodeableConcept | Claim subtype Binding: NZ Claim Subtypes (extensible)
patient |  | 1..1 | Reference(NZ Patient | Patient) | Patient with NHI
insurer |  | 0..0 |  |
provider |  | 1..1 | Reference(Organization) | Legal entity who submitted the claim
fundsReserve |  | 0..0 |  |
prescription |  | 0..0 |  |
originalPrescription |  | 0..0 |  |
payee |  | 0..0 |  |
careTeam |  | 0..0 |  |
supportingInfo |  | 0..* | BackboneElement | Additional attributes that may accompany a Claim
diagnosis |  | 0..0 |  |
procedure |  | 0..0 |  |
insurance |  | 1..1 | BackboneElement | Patient insurance information
accident |  | 0..0 |  |
item |  | 0..* | BackboneElement | Each individual product or service being claimed for as part of this claim
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:patientPaid |  | 0..1 | Money | Shared Care Patient Copayment URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-patient-copayment
sequence | S | 1..1 | positiveInt | Referred to by the ClaimResponse.item.itemSequence
Slices for location[x] |  | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Slice: Unordered, Open by type:$this
location[x]:locationReference |  | 0..1 | Reference(Location) | HPI Facility
unitPrice |  | 0..0 |  |
net |  | 0..0 |  |
total |  | 0..0 |  |
Documentation for this format

#### Terminology Bindings (Differential)

Path | Conformance | ValueSet | URI
Claim.type | extensible | NzClaimTypes `https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-types` From this IG
Claim.subType | extensible | NzClaimSubtypes(a valid code from NZ Claim Subtype Code System) `https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-subtypes` From this IG

#### Constraints

Id | Grade | Path(s) | Details | Requirements
hpiOrNzbnIdentifierPattern | error | Claim | Identifiers with system 'https://standards.digital.health.nz/ns/hpi-organisation-id', 'https://standards.digital.health.nz/ns/hpi-facility-id' or 'https://standards.digital.health.nz/ns/hpi-nzbn' must conform to the NZ HPI/NZBN identifier patterns. : %context.descendants().identifier.all( (system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')) ).exists() or %context.descendants().identifier.where( system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or system = 'https://standards.digital.health.nz/ns/hpi-facility-id' or system = 'https://standards.digital.health.nz/ns/hpi-nzbn' ).empty() |

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim | C | 0..* | Claim | Claim, Pre-determination or Pre-authorization Constraints: hpiOrNzbnIdentifierPattern
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 1..1 | Meta | Metadata about the resource
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
versionId | Σ | 0..1 | id | Version specific identifier
lastUpdated | Σ | 0..1 | instant | When the resource version last changed
source | Σ | 1..1 | uri | HPI Facility ID from where the record is sourced
profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag | Σ | 1..* | Coding | Correlation-id where the record is sourced Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:traceNumber |  | 0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
extension:agreementNumber |  | 1..1 | string | Shared Care Agreement Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-agreement-number
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | Business identifier(s) for the claim
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | Σ | 1..1 | CodeableConcept | Claim type Binding: NZ Claim Types (extensible)
subType |  | 0..1 | CodeableConcept | Claim subtype Binding: NZ Claim Subtypes (extensible)
use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
patient | Σ | 1..1 | Reference(NZ Patient | Patient) | Patient with NHI
billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim
created | Σ | 1..1 | dateTime | Resource creation date
enterer |  | 0..1 | Reference(Practitioner | PractitionerRole) | Author of the claim
provider | Σ | 1..1 | Reference(Organization) | Legal entity who submitted the claim
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
related |  | 0..* | BackboneElement | Prior or corollary claims
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
claim |  | 0..1 | Reference(Claim) | Reference to the related claim
relationship |  | 0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference |  | 0..1 | Identifier | File or case reference
referral |  | 0..1 | Reference(ServiceRequest) | Treatment referral
facility |  | 0..1 | Reference(Location) | Servicing facility
supportingInfo |  | 0..* | BackboneElement | Additional attributes that may accompany a Claim
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Information instance identifier
category |  | 1..1 | CodeableConcept | Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
code |  | 0..1 | CodeableConcept | Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
timing[x] |  | 0..1 |  | When it occurred
timingDate |  |  | date |
timingPeriod |  |  | Period |
value[x] |  | 0..1 |  | Data to be provided
valueBoolean |  |  | boolean |
valueString |  |  | string |
valueQuantity |  |  | Quantity |
valueAttachment |  |  | Attachment |
valueReference |  |  | Reference(Resource) |
reason |  | 0..1 | CodeableConcept | Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
insurance | Σ | 1..1 | BackboneElement | Patient insurance information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication
identifier |  | 0..1 | Identifier | Pre-assigned Claim number
coverage | Σ | 1..1 | Reference(Coverage) | Insurance information
businessArrangement |  | 0..1 | string | Additional provider contract number
preAuthRef |  | 0..* | string | Prior authorization reference number
claimResponse |  | 0..1 | Reference(ClaimResponse) | Adjudication results
item |  | 0..* | BackboneElement | Each individual product or service being claimed for as part of this claim
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:patientPaid |  | 0..1 | Money | Shared Care Patient Copayment URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-patient-copayment
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | S | 1..1 | positiveInt | Referred to by the ClaimResponse.item.itemSequence
careTeamSequence |  | 0..* | positiveInt | Applicable careTeam members
diagnosisSequence |  | 0..* | positiveInt | Applicable diagnoses
procedureSequence |  | 0..* | positiveInt | Applicable procedures
informationSequence |  | 0..* | positiveInt | Applicable exception and supporting information
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
Slices for location[x] |  | 0..1 |  | Place of service or where product was supplied Slice: Unordered, Open by type:$this Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept |  |  | CodeableConcept |
locationAddress |  |  | Address |
locationReference |  |  | Reference(Location) |
location[x]:locationReference |  | 0..1 | Reference(Location) | HPI Facility
quantity |  | 0..1 | SimpleQuantity | Count of products or services
factor |  | 0..1 | decimal | Price scaling factor
udi |  | 0..* | Reference(Device) | Unique device identifier
bodySite |  | 0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite |  | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
encounter |  | 0..* | Reference(Encounter) | Encounters related to this billed item
detail |  | 0..* | BackboneElement | Product or service provided
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity |  | 0..1 | SimpleQuantity | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
subDetail |  | 0..* | BackboneElement | Product or service provided
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Item instance identifier
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category |  | 0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity |  | 0..1 | SimpleQuantity | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
net |  | 0..1 | Money | Total item cost
udi |  | 0..* | Reference(Device) | Unique device identifier
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
Claim.meta.security | extensible | All Security Labels `http://hl7.org/fhir/ValueSet/security-labels` From the FHIR Standard
Claim.meta.tag | example | CommonTags `http://hl7.org/fhir/ValueSet/common-tags` From the FHIR Standard
Claim.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` From the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
Claim.status | required | FinancialResourceStatusCodes `http://hl7.org/fhir/ValueSet/fm-status|4.0.1` From the FHIR Standard
Claim.type | extensible | NzClaimTypes `https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-types` From this IG
Claim.subType | extensible | NzClaimSubtypes(a valid code from NZ Claim Subtype Code System) `https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-subtypes` From this IG
Claim.use | required | Use `http://hl7.org/fhir/ValueSet/claim-use|4.0.1` From the FHIR Standard
Claim.priority | example | ProcessPriorityCodes `http://hl7.org/fhir/ValueSet/process-priority` From the FHIR Standard
Claim.related.relationship | example | ExampleRelatedClaimRelationshipCodes `http://hl7.org/fhir/ValueSet/related-claim-relationship` From the FHIR Standard
Claim.payee.type | example | Claim Payee Type Codes `http://hl7.org/fhir/ValueSet/payeetype` From the FHIR Standard
Claim.careTeam.role | example | ClaimCareTeamRoleCodes `http://hl7.org/fhir/ValueSet/claim-careteamrole` From the FHIR Standard
Claim.careTeam.qualification | example | ExampleProviderQualificationCodes `http://hl7.org/fhir/ValueSet/provider-qualification` From the FHIR Standard
Claim.supportingInfo.category | example | ClaimInformationCategoryCodes `http://hl7.org/fhir/ValueSet/claim-informationcategory` From the FHIR Standard
Claim.supportingInfo.code | example | ExceptionCodes `http://hl7.org/fhir/ValueSet/claim-exception` From the FHIR Standard
Claim.supportingInfo.reason | example | MissingToothReasonCodes `http://hl7.org/fhir/ValueSet/missing-tooth-reason` From the FHIR Standard
Claim.diagnosis.diagnosis[x] | example | ICD-10Codes `http://hl7.org/fhir/ValueSet/icd-10` From the FHIR Standard
Claim.diagnosis.type | example | ExampleDiagnosisTypeCodes `http://hl7.org/fhir/ValueSet/ex-diagnosistype` From the FHIR Standard
Claim.diagnosis.onAdmission | example | ExampleDiagnosisOnAdmissionCodes `http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission` From the FHIR Standard
Claim.diagnosis.packageCode | example | ExampleDiagnosisRelatedGroupCodes `http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup` From the FHIR Standard
Claim.procedure.type | example | ExampleProcedureTypeCodes `http://hl7.org/fhir/ValueSet/ex-procedure-type` From the FHIR Standard
Claim.procedure.procedure[x] | example | ICD-10ProcedureCodes `http://hl7.org/fhir/ValueSet/icd-10-procedures` From the FHIR Standard
Claim.accident.type | extensible | ActIncidentCode `http://terminology.hl7.org/ValueSet/v3-ActIncidentCode`
Claim.item.revenue | example | ExampleRevenueCenterCodes `http://hl7.org/fhir/ValueSet/ex-revenue-center` From the FHIR Standard
Claim.item.category | example | BenefitCategoryCodes `http://hl7.org/fhir/ValueSet/ex-benefitcategory` From the FHIR Standard
Claim.item.productOrService | example | USCLSCodes `http://hl7.org/fhir/ValueSet/service-uscls` From the FHIR Standard
Claim.item.modifier | example | ModifierTypeCodes `http://hl7.org/fhir/ValueSet/claim-modifiers` From the FHIR Standard
Claim.item.programCode | example | ExampleProgramReasonCodes `http://hl7.org/fhir/ValueSet/ex-program-code` From the FHIR Standard
Claim.item.location[x] | example | ExampleServicePlaceCodes `http://hl7.org/fhir/ValueSet/service-place` From the FHIR Standard
Claim.item.bodySite | example | OralSiteCodes `http://hl7.org/fhir/ValueSet/tooth` From the FHIR Standard
Claim.item.subSite | example | SurfaceCodes `http://hl7.org/fhir/ValueSet/surface` From the FHIR Standard
Claim.item.detail.revenue | example | ExampleRevenueCenterCodes `http://hl7.org/fhir/ValueSet/ex-revenue-center` From the FHIR Standard
Claim.item.detail.category | example | BenefitCategoryCodes `http://hl7.org/fhir/ValueSet/ex-benefitcategory` From the FHIR Standard
Claim.item.detail.productOrService | example | USCLSCodes `http://hl7.org/fhir/ValueSet/service-uscls` From the FHIR Standard
Claim.item.detail.modifier | example | ModifierTypeCodes `http://hl7.org/fhir/ValueSet/claim-modifiers` From the FHIR Standard
Claim.item.detail.programCode | example | ExampleProgramReasonCodes `http://hl7.org/fhir/ValueSet/ex-program-code` From the FHIR Standard
Claim.item.detail.subDetail.revenue | example | ExampleRevenueCenterCodes `http://hl7.org/fhir/ValueSet/ex-revenue-center` From the FHIR Standard
Claim.item.detail.subDetail.category | example | BenefitCategoryCodes `http://hl7.org/fhir/ValueSet/ex-benefitcategory` From the FHIR Standard
Claim.item.detail.subDetail.productOrService | example | USCLSCodes `http://hl7.org/fhir/ValueSet/service-uscls` From the FHIR Standard
Claim.item.detail.subDetail.modifier | example | ModifierTypeCodes `http://hl7.org/fhir/ValueSet/claim-modifiers` From the FHIR Standard
Claim.item.detail.subDetail.programCode | example | ExampleProgramReasonCodes `http://hl7.org/fhir/ValueSet/ex-program-code` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() |
dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() |
dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Claim | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
hpiOrNzbnIdentifierPattern | error | Claim | Identifiers with system 'https://standards.digital.health.nz/ns/hpi-organisation-id', 'https://standards.digital.health.nz/ns/hpi-facility-id' or 'https://standards.digital.health.nz/ns/hpi-nzbn' must conform to the NZ HPI/NZBN identifier patterns. : %context.descendants().identifier.all( (system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')) ).exists() or %context.descendants().identifier.where( system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or system = 'https://standards.digital.health.nz/ns/hpi-facility-id' or system = 'https://standards.digital.health.nz/ns/hpi-nzbn' ).empty() |

This structure is derived from Claim

Summary

Mandatory: 5 elements
Must-Support: 1 element
Prohibited: 12 elements

Structures

This structure refers to these other structures:

- NZ Patient (http://hl7.org.nz/fhir/StructureDefinition/NzPatient)

Extensions

This structure refers to these extensions:

- https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
- https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-agreement-number
- https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-patient-copayment

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Claim.item.location[x]

Other representations of profile: CSV, Excel, Schematron