Health New Zealand Te Whatu Ora Shared Care FHIR API - Local Development build (v0.4.5) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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Resource Profile: NZ Pharmacy Claim

A FHIR resource profile for NZ Pharmacy Claims, including extensions for patient cohort and claimant information.

This profile is used to represent pharmacy claims in New Zealand, including patient cohort information and claimant details.

Usages:

• Examples for this Profile: Claim/NzPharmacyClaimExample2
• 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		0..*	Claim	Claim, Pre-determination or Pre-authorization
meta	Σ	1..1	Meta	Metadata about the resource
source	ΣC	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
profile	Σ	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Slices for tag	Σ	1..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:correlationId	Σ	1..1	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
code	Σ	1..1	code	Symbol in syntax defined by the system
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:patientCohort		0..1	CodeableConcept	Patient Cohort URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort Binding: Patient Cohort ValueSet (required)
extension:claimantNumber		1..1	string	Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number
extension:originatingClaimantNumber		0..1	string	Originating Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		1..*	Identifier	Business Identifier for claim
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
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	Category or discipline Binding: NZ Claim Types (extensible)
subType		1..1	CodeableConcept	More granular claim type 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)	The recipient of the products and services
type	Σ	1..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). Required Pattern: Patient
identifier	Σ	1..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/nhi-id
value	ΣC	1..1	string	Must be an absolute URL reference to the patient on the NHI system. See constraints for details. Constraints: nhi-value-format Example General: 123456
billablePeriod	Σ	1..1	Period	Relevant time frame for the claim
start	ΣC	1..1	dateTime	Starting time with inclusive boundary Constraints: date-only
end	ΣC	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: date-only
created	ΣC	1..1	dateTime	Resource creation date Constraints: full-datetime-with-timezone
provider	Σ	1..1	Reference(Organization)	Party responsible for the claim
identifier	ΣC	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
use	?!Σ	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	ΣC	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
value	Σ	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
priority	Σ	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
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		1..*	BackboneElement	Product or service provided
Slices for extension		3..*	Extension	Extension Slice: Unordered, Open by value:url
extension:patientFlag		0..1	boolean	Patient Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag
extension:request		1..1	(Complex)	Item Request URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request"
value[x]		1..1	Reference(NZ Medication Dispense)	Value of extension
extension:prescriberFlag		0..1	boolean	Prescriber Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag
extension:prescriptionFlag		0..1	boolean	Prescription Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag
extension:doseFlag		0..1	boolean	Dose Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag
extension:groupId		0..1	string	Group ID URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id
extension:transactionCategory		1..1	CodeableConcept	Transaction Category URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/transaction-category Binding: NZ Pharmacy Transaction Category (required)
extension:extendedSupplyFlag		0..1	boolean	Extended Supply Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/extended-supply-flag
extension:classification		0..1	(Complex)	Classification Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification"
value[x]		0..1	CodeableConcept	Value of extension Binding: NZ Pharmacy Claim Item Classification (required)
extension:pscFlag		1..1	boolean	PSC Flag Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/psc-flag
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Item instance identifier
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Slices for serviced[x]		1..1	Period	Date or dates of service or product delivery Slice: Unordered, Closed by type:$this
serviced[x]:servicedPeriod		1..1	Period	Date or dates of service or product delivery
start	ΣC	1..1	dateTime	Starting time with inclusive boundary Constraints: full-datetime-with-timezone
end	ΣC	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: full-datetime-with-timezone
detail		1..*	BackboneElement	Product or service provided
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:balanceOwing		0..1	string	Balance Owing URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing
extension:wastageQuantity		0..1	Quantity	Wastage Quantity URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity
extension:cbsSubsidy		0..1	Money	CBS Subsidy URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy
extension:cbsPackSize		0..1	Quantity	CBS Pack Size URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Item instance identifier
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
quantity		1..1	SimpleQuantity(4.0.1)	Count of products or services
net		1..1	Money	Total item cost
total		1..1	Money	Total claim cost
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.meta.tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
Claim.meta.tag:correlationId	Base	example	Common Tags	📍4.0.1	FHIR Std.
Claim.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	NZ Claim Types	📦0.4.5	This IG
Claim.subType	Base	extensible	NZ Claim Subtypes	📦0.4.5	This IG
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.patient.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.patient.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.provider.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.priority	Base	required	Process Priority Codes	📦4.0.1	FHIR Std.
Claim.payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.item.extension:classification.​value[x]	Base	required	NZ Pharmacy Claim Item Classification	📦0.4.5	This IG
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
allowedLocalIdentifierSystems	error	Claim.provider.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN	$this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
date-only	error	Claim.billablePeriod.start, Claim.billablePeriod.end	DateTime must be date-only in yyyy-mm-dd format. Time and timezone values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}$')
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()
full-datetime-with-timezone	error	Claim.created, Claim.item.serviced[x]:servicedPeriod.start, Claim.item.serviced[x]:servicedPeriod.end	DateTime must be ISO 8601 format with time and timezone (e.g., 2026-01-01T00:00:00+13:00 or 2026-01-01T00:00:00Z). Date-only values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}T[0-9]{2}:[0-9]{2}:[0-9]{2}(\\.[0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
hpi-location-url-format	error	Claim.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A	matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	Claim.provider.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic).	system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	Claim.provider.identifier	HPI Facility ID must conform to format (FXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	Claim.provider.identifier	HPI Organisation ID must conform to format (GXXnnn-C).	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]$')
nhi-value-format	error	Claim.patient.identifier.value	Reference must be an NHI Patient URL with format ZZZ1111 or ZZZ11AA	matches('^[A-Z]{3}([0-9]{4}|[0-9]{2}[A-Z]{2})$')
nzbnPattern	error	Claim.provider.identifier	NZBN must conform to format (13 digits).	system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
meta		1..1	Meta	Metadata about the resource
source	C	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
profile		1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Slices for tag		1..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:correlationId		1..1	Coding	Tags applied to this resource
system		1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
code		1..1	code	Symbol in syntax defined by the system
contained		0..0		Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:patientCohort		0..1	CodeableConcept	Patient Cohort URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort Binding: Patient Cohort ValueSet (required)
extension:claimantNumber		1..1	string	Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number
extension:originatingClaimantNumber		0..1	string	Originating Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number
identifier		1..*	Identifier	Business Identifier for claim
system		1..1	uri	The namespace for the identifier value
value		1..1	string	The value that is unique
type		1..1	CodeableConcept	Category or discipline Binding: NZ Claim Types (extensible)
subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
patient		1..1	Reference(NZ Patient | Patient)	The recipient of the products and services
type		1..1	uri	Type the reference refers to (e.g. "Patient") Required Pattern: Patient
identifier		1..1	Identifier	Logical reference, when literal reference is not known
system		1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/nhi-id
value	C	1..1	string	Must be an absolute URL reference to the patient on the NHI system. See constraints for details. Constraints: nhi-value-format
display		0..0		Text alternative for the resource
billablePeriod		1..1	Period	Relevant time frame for the claim
start	C	1..1	dateTime	Starting time with inclusive boundary Constraints: date-only
end	C	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: date-only
created	C	1..1	dateTime	Resource creation date Constraints: full-datetime-with-timezone
insurer		0..0		Target
provider		1..1	Reference(Organization)	Party responsible for the claim
identifier	C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
use		0..1	code	The local identifier use SHOULD be set to official.
system	C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
value		1..1	string	The actual local identifier value, e.g. GZZ999-Z Example Example HPI Org ID: GZZ999-Z
priority		1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
fundsReserve		0..0		For whom to reserve funds
prescription		0..0		Prescription authorizing services and products
originalPrescription		0..0		Original prescription if superseded by fulfiller
payee		0..0		Recipient of benefits payable
careTeam		0..0		Members of the care team
diagnosis		0..0		Pertinent diagnosis information
procedure		0..0		Clinical procedures performed
insurance		1..1	BackboneElement	Patient insurance information
accident		0..0		Details of the event
item		1..*	BackboneElement	Product or service provided
Slices for extension		3..*	Extension	Extension Slice: Unordered, Open by value:url
extension:patientFlag		0..1	boolean	Patient Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag
extension:request		1..1	(Complex)	Item Request URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request
value[x]		1..1	Reference(NZ Medication Dispense)	Value of extension
extension:prescriberFlag		0..1	boolean	Prescriber Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag
extension:prescriptionFlag		0..1	boolean	Prescription Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag
extension:doseFlag		0..1	boolean	Dose Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag
extension:groupId		0..1	string	Group ID URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id
extension:transactionCategory		1..1	CodeableConcept	Transaction Category URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/transaction-category Binding: NZ Pharmacy Transaction Category (required)
extension:extendedSupplyFlag		0..1	boolean	Extended Supply Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/extended-supply-flag
extension:classification		0..1	(Complex)	Classification Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification
value[x]		0..1	CodeableConcept	Value of extension Binding: NZ Pharmacy Claim Item Classification (required)
extension:pscFlag		1..1	boolean	PSC Flag Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/psc-flag
revenue		0..0		Revenue or cost center code
category		0..0		Benefit classification
modifier		0..0		Product or service billing modifiers
programCode		0..0		Program the product or service is provided under
Slices for serviced[x]		1..1	Period	Date or dates of service or product delivery Slice: Unordered, Open by type:$this
serviced[x]:servicedPeriod		1..1	Period	Date or dates of service or product delivery
start	C	1..1	dateTime	Starting time with inclusive boundary Constraints: full-datetime-with-timezone
end	C	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: full-datetime-with-timezone
udi		0..0		Unique device identifier
bodySite		0..0		Anatomical location
subSite		0..0		Anatomical sub-location
detail		1..*	BackboneElement	Product or service provided
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:balanceOwing		0..1	string	Balance Owing URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing
extension:wastageQuantity		0..1	Quantity	Wastage Quantity URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity
extension:cbsSubsidy		0..1	Money	CBS Subsidy URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy
extension:cbsPackSize		0..1	Quantity	CBS Pack Size URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize
revenue		0..0		Revenue or cost center code
category		0..0		Benefit classification
modifier		0..0		Service/Product billing modifiers
programCode		0..0		Program the product or service is provided under
quantity		1..1	SimpleQuantity(4.0.1)	Count of products or services
net		1..1	Money	Total item cost
udi		0..0		Unique device identifier
total		1..1	Money	Total claim cost
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Claim.type	Base	extensible	NZ Claim Types	📦0.4.5	This IG
Claim.subType	Base	extensible	NZ Claim Subtypes	📦0.4.5	This IG
Claim.priority	Base	required	Process Priority Codes	📦4.0.1	FHIR Std.
Claim.item.extension:classification.​value[x]	Base	required	NZ Pharmacy Claim Item Classification	📦0.4.5	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
allowedLocalIdentifierSystems	error	Claim.provider.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN	$this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
date-only	error	Claim.billablePeriod.start, Claim.billablePeriod.end	DateTime must be date-only in yyyy-mm-dd format. Time and timezone values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}$')
full-datetime-with-timezone	error	Claim.created, Claim.item.serviced[x]:servicedPeriod.start, Claim.item.serviced[x]:servicedPeriod.end	DateTime must be ISO 8601 format with time and timezone (e.g., 2026-01-01T00:00:00+13:00 or 2026-01-01T00:00:00Z). Date-only values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}T[0-9]{2}:[0-9]{2}:[0-9]{2}(\\.[0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
hpi-location-url-format	error	Claim.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A	matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	Claim.provider.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic).	system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	Claim.provider.identifier	HPI Facility ID must conform to format (FXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	Claim.provider.identifier	HPI Organisation ID must conform to format (GXXnnn-C).	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]$')
nhi-value-format	error	Claim.patient.identifier.value	Reference must be an NHI Patient URL with format ZZZ1111 or ZZZ11AA	matches('^[A-Z]{3}([0-9]{4}|[0-9]{2}[A-Z]{2})$')
nzbnPattern	error	Claim.provider.identifier	NZBN must conform to format (13 digits).	system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
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	ΣC	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
profile	Σ	1..1	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.
Slices for tag	Σ	1..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:correlationId	Σ	1..1	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
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
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:patientCohort		0..1	CodeableConcept	Patient Cohort URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort Binding: Patient Cohort ValueSet (required)
extension:claimantNumber		1..1	string	Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number
extension:originatingClaimantNumber		0..1	string	Originating Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		1..*	Identifier	Business Identifier for claim
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
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	Category or discipline Binding: NZ Claim Types (extensible)
subType		1..1	CodeableConcept	More granular claim type 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)	The recipient of the products and services
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	1..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). Required Pattern: Patient
identifier	Σ	1..1	Identifier	Logical reference, when literal reference is not known
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/nhi-id
value	ΣC	1..1	string	Must be an absolute URL reference to the patient on the NHI system. See constraints for details. Constraints: nhi-value-format Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
billablePeriod	Σ	1..1	Period	Relevant time frame for the claim
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	1..1	dateTime	Starting time with inclusive boundary Constraints: date-only
end	ΣC	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: date-only
created	ΣC	1..1	dateTime	Resource creation date Constraints: full-datetime-with-timezone
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
provider	Σ	1..1	Reference(Organization)	Party responsible for the claim
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	ΣC	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
value	Σ	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	Σ	0..1	string	Text alternative for the resource
priority	Σ	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
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	Supporting 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		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		1..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
Slices for extension		3..*	Extension	Extension Slice: Unordered, Open by value:url
extension:patientFlag		0..1	boolean	Patient Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag
extension:request		1..1	(Complex)	Item Request URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request"
value[x]		1..1	Reference(NZ Medication Dispense)	Value of extension
extension:prescriberFlag		0..1	boolean	Prescriber Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag
extension:prescriptionFlag		0..1	boolean	Prescription Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag
extension:doseFlag		0..1	boolean	Dose Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag
extension:groupId		0..1	string	Group ID URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id
extension:transactionCategory		1..1	CodeableConcept	Transaction Category URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/transaction-category Binding: NZ Pharmacy Transaction Category (required)
extension:extendedSupplyFlag		0..1	boolean	Extended Supply Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/extended-supply-flag
extension:classification		0..1	(Complex)	Classification Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification"
value[x]		0..1	CodeableConcept	Value of extension Binding: NZ Pharmacy Claim Item Classification (required)
extension:pscFlag		1..1	boolean	PSC Flag Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/psc-flag
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Item instance identifier
careTeamSequence		0..*	positiveInt	Applicable careTeam members
diagnosisSequence		0..*	positiveInt	Applicable diagnoses
procedureSequence		0..*	positiveInt	Applicable procedures
informationSequence		0..*	positiveInt	Applicable exception and supporting information
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Slices for serviced[x]		1..1	Period	Date or dates of service or product delivery Slice: Unordered, Closed by type:$this
serviced[x]:servicedPeriod		1..1	Period	Date or dates of service or product delivery
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	1..1	dateTime	Starting time with inclusive boundary Constraints: full-datetime-with-timezone
end	ΣC	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: full-datetime-with-timezone
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	SimpleQuantity(4.0.1)	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
encounter		0..*	Reference(Encounter)	Encounters related to this billed item
detail		1..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:balanceOwing		0..1	string	Balance Owing URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing
extension:wastageQuantity		0..1	Quantity	Wastage Quantity URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity
extension:cbsSubsidy		0..1	Money	CBS Subsidy URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy
extension:cbsPackSize		0..1	Quantity	CBS Pack Size URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Item instance identifier
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
quantity		1..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		1..1	Money	Total item cost
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(4.0.1)	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
total		1..1	Money	Total claim cost
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.meta.security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
Claim.meta.tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
Claim.meta.tag:correlationId	Base	example	Common Tags	📍4.0.1	FHIR Std.
Claim.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Claim.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.identifier.type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	NZ Claim Types	📦0.4.5	This IG
Claim.subType	Base	extensible	NZ Claim Subtypes	📦0.4.5	This IG
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.patient.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.patient.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.patient.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Claim.provider.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.provider.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.provider.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Claim.priority	Base	required	Process Priority Codes	📦4.0.1	FHIR Std.
Claim.related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.0.1	FHIR Std.
Claim.payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
Claim.careTeam.role	Base	example	Claim Care Team Role Codes	📍4.0.1	FHIR Std.
Claim.careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.0.1	FHIR Std.
Claim.procedure.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.accident.type	Base	extensible	ActIncidentCode	📦3.0.0	THO v6.5
Claim.item.extension:classification.​value[x]	Base	required	NZ Pharmacy Claim Item Classification	📦0.4.5	This IG
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
allowedLocalIdentifierSystems	error	Claim.provider.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN	$this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
date-only	error	Claim.billablePeriod.start, Claim.billablePeriod.end	DateTime must be date-only in yyyy-mm-dd format. Time and timezone values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}$')
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()
full-datetime-with-timezone	error	Claim.created, Claim.item.serviced[x]:servicedPeriod.start, Claim.item.serviced[x]:servicedPeriod.end	DateTime must be ISO 8601 format with time and timezone (e.g., 2026-01-01T00:00:00+13:00 or 2026-01-01T00:00:00Z). Date-only values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}T[0-9]{2}:[0-9]{2}:[0-9]{2}(\\.[0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
hpi-location-url-format	error	Claim.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A	matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	Claim.provider.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic).	system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	Claim.provider.identifier	HPI Facility ID must conform to format (FXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	Claim.provider.identifier	HPI Organisation ID must conform to format (GXXnnn-C).	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]$')
nhi-value-format	error	Claim.patient.identifier.value	Reference must be an NHI Patient URL with format ZZZ1111 or ZZZ11AA	matches('^[A-Z]{3}([0-9]{4}|[0-9]{2}[A-Z]{2})$')
nzbnPattern	error	Claim.provider.identifier	NZBN must conform to format (13 digits).	system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

This structure is derived from Claim

Summary

Mandatory: 35 elements
Fixed: 1 element
Prohibited: 23 elements

Structures

This structure refers to these other structures:

• NZ Patient (http://hl7.org.nz/fhir/StructureDefinition/NzPatient)
• NZ Medication Dispense (https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/NzPharmacyMedicationDispense)

Extensions

This structure refers to these extensions:

• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/transaction-category
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/extended-supply-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/psc-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Claim.meta.tag
• The element 1 is sliced based on the value of Claim.item.serviced[x]

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
meta	Σ	1..1	Meta	Metadata about the resource
source	ΣC	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
profile	Σ	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Slices for tag	Σ	1..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:correlationId	Σ	1..1	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
code	Σ	1..1	code	Symbol in syntax defined by the system
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:patientCohort		0..1	CodeableConcept	Patient Cohort URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort Binding: Patient Cohort ValueSet (required)
extension:claimantNumber		1..1	string	Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number
extension:originatingClaimantNumber		0..1	string	Originating Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		1..*	Identifier	Business Identifier for claim
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
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	Category or discipline Binding: NZ Claim Types (extensible)
subType		1..1	CodeableConcept	More granular claim type 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)	The recipient of the products and services
type	Σ	1..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). Required Pattern: Patient
identifier	Σ	1..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/nhi-id
value	ΣC	1..1	string	Must be an absolute URL reference to the patient on the NHI system. See constraints for details. Constraints: nhi-value-format Example General: 123456
billablePeriod	Σ	1..1	Period	Relevant time frame for the claim
start	ΣC	1..1	dateTime	Starting time with inclusive boundary Constraints: date-only
end	ΣC	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: date-only
created	ΣC	1..1	dateTime	Resource creation date Constraints: full-datetime-with-timezone
provider	Σ	1..1	Reference(Organization)	Party responsible for the claim
identifier	ΣC	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
use	?!Σ	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	ΣC	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
value	Σ	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
priority	Σ	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
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		1..*	BackboneElement	Product or service provided
Slices for extension		3..*	Extension	Extension Slice: Unordered, Open by value:url
extension:patientFlag		0..1	boolean	Patient Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag
extension:request		1..1	(Complex)	Item Request URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request"
value[x]		1..1	Reference(NZ Medication Dispense)	Value of extension
extension:prescriberFlag		0..1	boolean	Prescriber Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag
extension:prescriptionFlag		0..1	boolean	Prescription Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag
extension:doseFlag		0..1	boolean	Dose Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag
extension:groupId		0..1	string	Group ID URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id
extension:transactionCategory		1..1	CodeableConcept	Transaction Category URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/transaction-category Binding: NZ Pharmacy Transaction Category (required)
extension:extendedSupplyFlag		0..1	boolean	Extended Supply Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/extended-supply-flag
extension:classification		0..1	(Complex)	Classification Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification"
value[x]		0..1	CodeableConcept	Value of extension Binding: NZ Pharmacy Claim Item Classification (required)
extension:pscFlag		1..1	boolean	PSC Flag Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/psc-flag
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Item instance identifier
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Slices for serviced[x]		1..1	Period	Date or dates of service or product delivery Slice: Unordered, Closed by type:$this
serviced[x]:servicedPeriod		1..1	Period	Date or dates of service or product delivery
start	ΣC	1..1	dateTime	Starting time with inclusive boundary Constraints: full-datetime-with-timezone
end	ΣC	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: full-datetime-with-timezone
detail		1..*	BackboneElement	Product or service provided
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:balanceOwing		0..1	string	Balance Owing URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing
extension:wastageQuantity		0..1	Quantity	Wastage Quantity URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity
extension:cbsSubsidy		0..1	Money	CBS Subsidy URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy
extension:cbsPackSize		0..1	Quantity	CBS Pack Size URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Item instance identifier
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
quantity		1..1	SimpleQuantity(4.0.1)	Count of products or services
net		1..1	Money	Total item cost
total		1..1	Money	Total claim cost
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.meta.tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
Claim.meta.tag:correlationId	Base	example	Common Tags	📍4.0.1	FHIR Std.
Claim.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	NZ Claim Types	📦0.4.5	This IG
Claim.subType	Base	extensible	NZ Claim Subtypes	📦0.4.5	This IG
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.patient.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.patient.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.provider.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.priority	Base	required	Process Priority Codes	📦4.0.1	FHIR Std.
Claim.payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.item.extension:classification.​value[x]	Base	required	NZ Pharmacy Claim Item Classification	📦0.4.5	This IG
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
allowedLocalIdentifierSystems	error	Claim.provider.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN	$this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
date-only	error	Claim.billablePeriod.start, Claim.billablePeriod.end	DateTime must be date-only in yyyy-mm-dd format. Time and timezone values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}$')
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()
full-datetime-with-timezone	error	Claim.created, Claim.item.serviced[x]:servicedPeriod.start, Claim.item.serviced[x]:servicedPeriod.end	DateTime must be ISO 8601 format with time and timezone (e.g., 2026-01-01T00:00:00+13:00 or 2026-01-01T00:00:00Z). Date-only values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}T[0-9]{2}:[0-9]{2}:[0-9]{2}(\\.[0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
hpi-location-url-format	error	Claim.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A	matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	Claim.provider.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic).	system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	Claim.provider.identifier	HPI Facility ID must conform to format (FXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	Claim.provider.identifier	HPI Organisation ID must conform to format (GXXnnn-C).	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]$')
nhi-value-format	error	Claim.patient.identifier.value	Reference must be an NHI Patient URL with format ZZZ1111 or ZZZ11AA	matches('^[A-Z]{3}([0-9]{4}|[0-9]{2}[A-Z]{2})$')
nzbnPattern	error	Claim.provider.identifier	NZBN must conform to format (13 digits).	system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

Differential View

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
meta		1..1	Meta	Metadata about the resource
source	C	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
profile		1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Slices for tag		1..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:correlationId		1..1	Coding	Tags applied to this resource
system		1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
code		1..1	code	Symbol in syntax defined by the system
contained		0..0		Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:patientCohort		0..1	CodeableConcept	Patient Cohort URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort Binding: Patient Cohort ValueSet (required)
extension:claimantNumber		1..1	string	Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number
extension:originatingClaimantNumber		0..1	string	Originating Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number
identifier		1..*	Identifier	Business Identifier for claim
system		1..1	uri	The namespace for the identifier value
value		1..1	string	The value that is unique
type		1..1	CodeableConcept	Category or discipline Binding: NZ Claim Types (extensible)
subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
patient		1..1	Reference(NZ Patient | Patient)	The recipient of the products and services
type		1..1	uri	Type the reference refers to (e.g. "Patient") Required Pattern: Patient
identifier		1..1	Identifier	Logical reference, when literal reference is not known
system		1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/nhi-id
value	C	1..1	string	Must be an absolute URL reference to the patient on the NHI system. See constraints for details. Constraints: nhi-value-format
display		0..0		Text alternative for the resource
billablePeriod		1..1	Period	Relevant time frame for the claim
start	C	1..1	dateTime	Starting time with inclusive boundary Constraints: date-only
end	C	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: date-only
created	C	1..1	dateTime	Resource creation date Constraints: full-datetime-with-timezone
insurer		0..0		Target
provider		1..1	Reference(Organization)	Party responsible for the claim
identifier	C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
use		0..1	code	The local identifier use SHOULD be set to official.
system	C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
value		1..1	string	The actual local identifier value, e.g. GZZ999-Z Example Example HPI Org ID: GZZ999-Z
priority		1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
fundsReserve		0..0		For whom to reserve funds
prescription		0..0		Prescription authorizing services and products
originalPrescription		0..0		Original prescription if superseded by fulfiller
payee		0..0		Recipient of benefits payable
careTeam		0..0		Members of the care team
diagnosis		0..0		Pertinent diagnosis information
procedure		0..0		Clinical procedures performed
insurance		1..1	BackboneElement	Patient insurance information
accident		0..0		Details of the event
item		1..*	BackboneElement	Product or service provided
Slices for extension		3..*	Extension	Extension Slice: Unordered, Open by value:url
extension:patientFlag		0..1	boolean	Patient Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag
extension:request		1..1	(Complex)	Item Request URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request
value[x]		1..1	Reference(NZ Medication Dispense)	Value of extension
extension:prescriberFlag		0..1	boolean	Prescriber Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag
extension:prescriptionFlag		0..1	boolean	Prescription Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag
extension:doseFlag		0..1	boolean	Dose Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag
extension:groupId		0..1	string	Group ID URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id
extension:transactionCategory		1..1	CodeableConcept	Transaction Category URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/transaction-category Binding: NZ Pharmacy Transaction Category (required)
extension:extendedSupplyFlag		0..1	boolean	Extended Supply Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/extended-supply-flag
extension:classification		0..1	(Complex)	Classification Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification
value[x]		0..1	CodeableConcept	Value of extension Binding: NZ Pharmacy Claim Item Classification (required)
extension:pscFlag		1..1	boolean	PSC Flag Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/psc-flag
revenue		0..0		Revenue or cost center code
category		0..0		Benefit classification
modifier		0..0		Product or service billing modifiers
programCode		0..0		Program the product or service is provided under
Slices for serviced[x]		1..1	Period	Date or dates of service or product delivery Slice: Unordered, Open by type:$this
serviced[x]:servicedPeriod		1..1	Period	Date or dates of service or product delivery
start	C	1..1	dateTime	Starting time with inclusive boundary Constraints: full-datetime-with-timezone
end	C	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: full-datetime-with-timezone
udi		0..0		Unique device identifier
bodySite		0..0		Anatomical location
subSite		0..0		Anatomical sub-location
detail		1..*	BackboneElement	Product or service provided
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:balanceOwing		0..1	string	Balance Owing URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing
extension:wastageQuantity		0..1	Quantity	Wastage Quantity URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity
extension:cbsSubsidy		0..1	Money	CBS Subsidy URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy
extension:cbsPackSize		0..1	Quantity	CBS Pack Size URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize
revenue		0..0		Revenue or cost center code
category		0..0		Benefit classification
modifier		0..0		Service/Product billing modifiers
programCode		0..0		Program the product or service is provided under
quantity		1..1	SimpleQuantity(4.0.1)	Count of products or services
net		1..1	Money	Total item cost
udi		0..0		Unique device identifier
total		1..1	Money	Total claim cost
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Claim.type	Base	extensible	NZ Claim Types	📦0.4.5	This IG
Claim.subType	Base	extensible	NZ Claim Subtypes	📦0.4.5	This IG
Claim.priority	Base	required	Process Priority Codes	📦4.0.1	FHIR Std.
Claim.item.extension:classification.​value[x]	Base	required	NZ Pharmacy Claim Item Classification	📦0.4.5	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
allowedLocalIdentifierSystems	error	Claim.provider.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN	$this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
date-only	error	Claim.billablePeriod.start, Claim.billablePeriod.end	DateTime must be date-only in yyyy-mm-dd format. Time and timezone values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}$')
full-datetime-with-timezone	error	Claim.created, Claim.item.serviced[x]:servicedPeriod.start, Claim.item.serviced[x]:servicedPeriod.end	DateTime must be ISO 8601 format with time and timezone (e.g., 2026-01-01T00:00:00+13:00 or 2026-01-01T00:00:00Z). Date-only values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}T[0-9]{2}:[0-9]{2}:[0-9]{2}(\\.[0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
hpi-location-url-format	error	Claim.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A	matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	Claim.provider.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic).	system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	Claim.provider.identifier	HPI Facility ID must conform to format (FXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	Claim.provider.identifier	HPI Organisation ID must conform to format (GXXnnn-C).	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]$')
nhi-value-format	error	Claim.patient.identifier.value	Reference must be an NHI Patient URL with format ZZZ1111 or ZZZ11AA	matches('^[A-Z]{3}([0-9]{4}|[0-9]{2}[A-Z]{2})$')
nzbnPattern	error	Claim.provider.identifier	NZBN must conform to format (13 digits).	system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
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	ΣC	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
profile	Σ	1..1	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.
Slices for tag	Σ	1..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:correlationId	Σ	1..1	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
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
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:patientCohort		0..1	CodeableConcept	Patient Cohort URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort Binding: Patient Cohort ValueSet (required)
extension:claimantNumber		1..1	string	Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number
extension:originatingClaimantNumber		0..1	string	Originating Claimant Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		1..*	Identifier	Business Identifier for claim
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
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	Category or discipline Binding: NZ Claim Types (extensible)
subType		1..1	CodeableConcept	More granular claim type 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)	The recipient of the products and services
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	1..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). Required Pattern: Patient
identifier	Σ	1..1	Identifier	Logical reference, when literal reference is not known
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/nhi-id
value	ΣC	1..1	string	Must be an absolute URL reference to the patient on the NHI system. See constraints for details. Constraints: nhi-value-format Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
billablePeriod	Σ	1..1	Period	Relevant time frame for the claim
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	1..1	dateTime	Starting time with inclusive boundary Constraints: date-only
end	ΣC	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: date-only
created	ΣC	1..1	dateTime	Resource creation date Constraints: full-datetime-with-timezone
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
provider	Σ	1..1	Reference(Organization)	Party responsible for the claim
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	ΣC	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
value	Σ	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	Σ	0..1	string	Text alternative for the resource
priority	Σ	1..1	CodeableConcept	Desired processing ugency Binding: ProcessPriorityCodes (required)
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	Supporting 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		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		1..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
Slices for extension		3..*	Extension	Extension Slice: Unordered, Open by value:url
extension:patientFlag		0..1	boolean	Patient Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag
extension:request		1..1	(Complex)	Item Request URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request"
value[x]		1..1	Reference(NZ Medication Dispense)	Value of extension
extension:prescriberFlag		0..1	boolean	Prescriber Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag
extension:prescriptionFlag		0..1	boolean	Prescription Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag
extension:doseFlag		0..1	boolean	Dose Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag
extension:groupId		0..1	string	Group ID URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id
extension:transactionCategory		1..1	CodeableConcept	Transaction Category URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/transaction-category Binding: NZ Pharmacy Transaction Category (required)
extension:extendedSupplyFlag		0..1	boolean	Extended Supply Flag URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/extended-supply-flag
extension:classification		0..1	(Complex)	Classification Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification"
value[x]		0..1	CodeableConcept	Value of extension Binding: NZ Pharmacy Claim Item Classification (required)
extension:pscFlag		1..1	boolean	PSC Flag Extension URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/psc-flag
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Item instance identifier
careTeamSequence		0..*	positiveInt	Applicable careTeam members
diagnosisSequence		0..*	positiveInt	Applicable diagnoses
procedureSequence		0..*	positiveInt	Applicable procedures
informationSequence		0..*	positiveInt	Applicable exception and supporting information
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Slices for serviced[x]		1..1	Period	Date or dates of service or product delivery Slice: Unordered, Closed by type:$this
serviced[x]:servicedPeriod		1..1	Period	Date or dates of service or product delivery
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	1..1	dateTime	Starting time with inclusive boundary Constraints: full-datetime-with-timezone
end	ΣC	1..1	dateTime	End time with inclusive boundary, if not ongoing Constraints: full-datetime-with-timezone
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	SimpleQuantity(4.0.1)	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
encounter		0..*	Reference(Encounter)	Encounters related to this billed item
detail		1..*	BackboneElement	Product or service provided
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:balanceOwing		0..1	string	Balance Owing URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing
extension:wastageQuantity		0..1	Quantity	Wastage Quantity URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity
extension:cbsSubsidy		0..1	Money	CBS Subsidy URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy
extension:cbsPackSize		0..1	Quantity	CBS Pack Size URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Item instance identifier
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
quantity		1..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		1..1	Money	Total item cost
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(4.0.1)	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
total		1..1	Money	Total claim cost
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.meta.security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
Claim.meta.tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
Claim.meta.tag:correlationId	Base	example	Common Tags	📍4.0.1	FHIR Std.
Claim.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Claim.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.identifier.type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	NZ Claim Types	📦0.4.5	This IG
Claim.subType	Base	extensible	NZ Claim Subtypes	📦0.4.5	This IG
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.patient.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.patient.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.patient.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Claim.provider.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Claim.provider.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Claim.provider.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Claim.priority	Base	required	Process Priority Codes	📦4.0.1	FHIR Std.
Claim.related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.0.1	FHIR Std.
Claim.payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
Claim.careTeam.role	Base	example	Claim Care Team Role Codes	📍4.0.1	FHIR Std.
Claim.careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	example	ICD-10 Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.0.1	FHIR Std.
Claim.procedure.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.accident.type	Base	extensible	ActIncidentCode	📦3.0.0	THO v6.5
Claim.item.extension:classification.​value[x]	Base	required	NZ Pharmacy Claim Item Classification	📦0.4.5	This IG
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
allowedLocalIdentifierSystems	error	Claim.provider.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN	$this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
date-only	error	Claim.billablePeriod.start, Claim.billablePeriod.end	DateTime must be date-only in yyyy-mm-dd format. Time and timezone values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}$')
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()
full-datetime-with-timezone	error	Claim.created, Claim.item.serviced[x]:servicedPeriod.start, Claim.item.serviced[x]:servicedPeriod.end	DateTime must be ISO 8601 format with time and timezone (e.g., 2026-01-01T00:00:00+13:00 or 2026-01-01T00:00:00Z). Date-only values are not accepted.	toString().matches('^[0-9]{4}-[0-9]{2}-[0-9]{2}T[0-9]{2}:[0-9]{2}:[0-9]{2}(\\.[0-9]+)?(Z|[+-][0-9]{2}:[0-9]{2})$')
hpi-location-url-format	error	Claim.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A	matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	Claim.provider.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic).	system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	Claim.provider.identifier	HPI Facility ID must conform to format (FXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	Claim.provider.identifier	HPI Organisation ID must conform to format (GXXnnn-C).	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]$')
nhi-value-format	error	Claim.patient.identifier.value	Reference must be an NHI Patient URL with format ZZZ1111 or ZZZ11AA	matches('^[A-Z]{3}([0-9]{4}|[0-9]{2}[A-Z]{2})$')
nzbnPattern	error	Claim.provider.identifier	NZBN must conform to format (13 digits).	system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

This structure is derived from Claim

Summary

Mandatory: 35 elements
Fixed: 1 element
Prohibited: 23 elements

Structures

This structure refers to these other structures:

• NZ Patient (http://hl7.org.nz/fhir/StructureDefinition/NzPatient)
• NZ Medication Dispense (https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/NzPharmacyMedicationDispense)

Extensions

This structure refers to these extensions:

• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-cohort
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/claimant-number
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/originating-claimant-number
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/patient-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/item-request
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescriber-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/prescription-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/dose-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/group-id
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/transaction-category
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/extended-supply-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/classification
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/psc-flag
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/hsaap-balance-owing
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/wastageQuantity
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsSubsidy
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/cbsPackSize

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Claim.meta.tag
• The element 1 is sliced based on the value of Claim.item.serviced[x]